Download PDF
Exp Clin Endocrinol Diabetes 2000; Vol. 108(2): 93-99
DOI: 10.1055/s-2000-5802
Articles

© Johann Ambrosius Barth

Prevalence and atherosclerosis risk in different types of non-diabetic hyperglycemia. Is mild hyperglycemia an underestimated evil?

T. Temelkova-Kurktschiev 1 , E. Henkel 1 , F. Schaper 1 , C. Koehler 1 , G. Siegert 2 , M. Hanefeld 1
  • 1 Institute and Outpatient Clinic of Metabolic Research
  • 2 Institute of Clinical Chemistry, Technical University Dresden, Germany
Further Information

Publication History

Publication Date:
31 December 2000 (online)

Also available at
    Permissions and Reprints

Summary:

So far little is known about the importance of different types of non-diabetic hyperglycemia for the development of macrovascular disease. The aim of this work was to examine the intima-media thickness (IMT) of the common carotid artery (CCA), a well-accepted marker of atherosclerosis, as well as various risk factors for atherosclerosis in non-diabetic subjects with isolated fasting (IFH; n = 67), isolated postchallenge (IPH; n = 82) and combined hyperglycemia (CH; n = 88) in comparison to normoglycemic (NG; n = 265) controls. Subjects were participants of the RIAD study (Risk Factors in IGT for Atherosclerosis and Diabetes). IMT in the IPH (IMTmean: 0.89 ± 0.02 mm; IMTmax: 1.01 ± 0.02 mm; mean ± SEM) and CH group (IMTmean: 0.91 ± 0.02 mm; IMTmax: 1.03 ± 0.02 mm) was significantly increased vs. the NG (IMTmean: 0.82 ± 0.01 mm; IMTmax: 0.94 ± 0.01 mm) and IFH group (IMTmean: 0.81 ± 0.02 mm; IMTmax: 0.90 ± 0.03 mm). IMT of the IFH group was similar to the normoglycemic controls. Subjects in the first and second tertile for postchallenge plasma glucose have similar carotid IMT irrespective of the level of fasting plasma glucose. The individuals of the third tertile for 2 h plasma glucose, whether in the first, second or third tertile of fasting plasma glucose, showed the same carotid IMT, which was significantly higher than all other groups, except for the one with lowest tertile for fasting and postchallenge plasma glucose. Except for total cholesterol and von Willebrand factor the levels of all other risk parameters were significantly higher in the hyperglycemic groups in comparison to the normoglycemic controls. Among the hyperglycemic subjects the CH group was at the highest risk for atherosclerosis with significantly increased levels of plasma triglycerides, fibrinogen, PAI-1, albuminuria, HDL-triglycerides, free fatty acids, insulin and proinsulin, and significantly reduced HDL-cholesterol in comparison to the normoglycemic controls. In summary, postchallenge hyperglycemia within the non-diabetic range is associated with atherosclerosis, as measured by the increased intima-media thickness of the common carotid artery. Furthermore, cardiovascular risk factors are significantly raised in all types of non-diabetic hyperglycemia.

Key words:

Hyperglycemia - intima-media thickness - atherosclerosis - postprandial state - coronary risk factors

References

  • 1 Alberti K GMM, Zimmet R Z. for the WHO Consultation . Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: Diagnosis and classification of diabetes mellitus provisional report of a WHO Consultation.  Diabetic Medicine. 15 539-553 1998; 
    CrossrefPubMedGoogle Scholar
  • 2 Andersson D KG, Svardsudd K. Long-term glycemic control relates to mortality in type II diabetes.  Diabetes Care. 18 1534-1543 1995; 
    PubMedGoogle Scholar
  • 3 Austin M A. Small, dense low-density lipoprotein as a risk factor for coronary heart disease.  Int J Clin Lab Res. 24 187-192 1994; 
    PubMedGoogle Scholar
  • 4 Barrett-Connor E. Does hyperglycemia really cause coronary heart disease?.  Diabetes Care. 20 1620-1623 1997; 
    CrossrefPubMedGoogle Scholar
  • 5 Barrett-Connor E, Ferrara A. Isolated postchallenge hyperglycemia and the risk of fatal cardiovascular disease in older women and men. The Rancho Bernardo Study.  Diabetes Care. 21 1236-1239 1998; 
    CrossrefPubMedGoogle Scholar
  • 6 Belcaro G, Geroulakos G, Laurora G, Cesarone M R, De Sanctis M T, Incandela L, Barsotti A. Inter/intra-observer variability of carotid and femoral bifurcation intima-media thickness measurements.  Panminerva Med. 35 (2) 75-79 1993; 
    PubMedGoogle Scholar
  • 7 Bots M L, Mulder P G, Hofman A, vanEs G A, Grobbee D E. Reproducibility of carotid vessel wall thickness measurements. The Rotterdam Study.  J-Clin-Epidemiol. 47 (8) 921-930 1994; 
    PubMedGoogle Scholar
  • 8 Damsgaard E M, Froland A, Jorgensen O D, Mogensen C E. Microalbuminuria as predictor of increased mortality in elderly people.  BMJ. 300 297-300 1990; 
    PubMedGoogle Scholar
  • 9 The Expert Committee on the Diagnosis and Classification of Diabetes mellitus . Report of the Expert Committee on the Diagnosis and Classification of Diabetes mellitus.  Diabetes Care. 20 1183-1197 1997; 
    PubMedGoogle Scholar
  • 10 Fujii S. PAI-1 in thrombosis and arteriosclerosis.  Fibrinolysis and Proteolysis. 11 (2) 137-140 1997; 
    PubMedGoogle Scholar
  • 11 Gariepy J, Massonneau M, Levenson J, Heudes D, Simon A. Evidence for in vivo carotid and femoral wall thickening in human hypertension. Groupe de Prevention Cardiovasculaire en Medecine du Travail.  Hypertension. 22 111-118 1993; 
    PubMedGoogle Scholar
  • 12 Gerstein H G, Yusuf S. Dysglycemia and risk of cardiovascular disease.  Lancet. 347 949-950 1996; 
    CrossrefPubMedGoogle Scholar
  • 13 Hanefeld M, Fischer S, Julius U, Schulze J, Schwanebeck U, Schmechel H, Ziegelasch H J, Lindner J. the DIS Group . Risk factors for myocardial infarction and death in newly detected NIDDM: the Diabetes Intervention Study, 11-year follow-up.  Diabetologia. 39 1577-1583 1996; 
    CrossrefPubMedGoogle Scholar
  • 14 Hanefeld M, Temelkova-Kurktschiev T. The postprandial state and the risk of atherosclerosis.  Diabetic Medicine. 14 S6-S11 1997; 
    CrossrefPubMedGoogle Scholar
  • 15 Hanefeld M, Köhler C, Schaper F, Fuecker K, Henkel E, Temelkova-Kurktschiev T. Postprandial plasma glucose is an independent risk factor for increased carotid intima-media thickness in non-diabetic individuals.  Atherosclerosis. 144 229-235 1999; 
    CrossrefPubMedGoogle Scholar
  • 16 Hanefeld M, Temelkova-Kurktschiev T, Schaper F, Henkel E, Siegert G, Koehler C. Impaired fasting glucose (IFG) is not a risk factor for atherosclerosis.  Diabetic Medicine. 16 212-218 1999; 
    CrossrefPubMedGoogle Scholar
  • 17 Kannel W B, McGee D L. Diabetes and cardiovascular disease. The Framingham study.  J Am Med Assoc. 241 2035-2038 1979; 
    CrossrefPubMedGoogle Scholar
  • 18 Klein R. Hyperglycemia and microvascular and macrovascular disease in diabetes.  Diabetes Care. 18 258-268 1995; 
    PubMedGoogle Scholar
  • 19 Laakso M, Kuusisto J. Epidemiological evidence for the association of hyperglycemia and atherosclerotic vascular disease in non-insulin-dependent diabetes mellitus.  Ann Med. 28 415-418 1996; 
    CrossrefPubMedGoogle Scholar
  • 20 Mogensen C E. Microalbuminuria predicts clinical proteinuria and early mortality in maturity-onset diabetes.  The New England Journal of Medicine. 310 356-360 1984; 
    PubMedGoogle Scholar
  • 21 Ohlson L O, Svardsud K, Welin L, Eriksson H, Wilhelmsen L, Tibblin G, Larsson B. Fasting blood glucose and risk of coronary heart disease, stroke, and all-cause mortality: a 17-year follow-up study of men born in 1913.  Diabet Med. 3 33-37 1986; 
    PubMedGoogle Scholar
  • 22 O'Leary D H, Polak J F, Kronmal R A, Manolio T A, Burke G L, Wolfson S K. for the Cardiovascular Health Study Collaborative Research Group . Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults.  N Engl J Med. 340 14-22 1999; 
    CrossrefPubMedGoogle Scholar
  • 23 Persson J, Stavenow L, Wikstrand J, Israelsson B, Formgren J, Berglund G. Noninvasive quantification of atherosclerotic lesions. Reproducibility of ultrasonographic measurement of arterial wall thickness and plaque size.  Arteriosclerosis and Thrombosis. 12 261-266 1992; 
    PubMedGoogle Scholar
  • 24 Pignoli P, Tremoli E, Poli A, Oreste P, Paoletti R. Intimal plus medial thickness of the arterial wall: A direct measurement with ultrasound imaging.  Circulation. 74 1399-1406 1986; 
    CrossrefPubMedGoogle Scholar
  • 25 Salonen J T, Salonen R. Ultrasound assessed carotid morphology and the risk of coronary heart disease.  Arterioscler Thromb. 11 1245-1249 1991; 
    CrossrefPubMedGoogle Scholar
  • 26 Scheidt-Nave C, Barrett-Connor E, Wingard D L, Cohn B A, Edelstein S L. Sex differences in fasting glycemia as a risk factor for ischemic heart disease death.  Am J Epidemiol. 133 565-576 1991; 
    PubMedGoogle Scholar
  • 27 Stamler R, Stamler J, Lindberg H A. Asymptomatic hyperglycemia and coronary heart disease in middle-aged men in two employed populations in Chicago.  J Chron Dis. 32 805-815 1979; 
    CrossrefPubMedGoogle Scholar
  • 28 Stern M P. Glycemia and cardiovascular risk.  Diabetes Care. 20 1501-1502 1997; 
    PubMedGoogle Scholar
  • 29 Temelkova-Kurktschiev T, Hanefeld M, Leonhardt W. Small dense low-density lipoprotein (LDL) in non-insulin-dependent diabetes mellitus (NIDDM). Impact of hypertriglyceridemia.  Annals of the New York Academy of Sciences (NYAS). 827 279-287 1997; 
    PubMedGoogle Scholar
  • 30 Temelkova-Kurktschiev T, Koehler C, Schaper F, Henkel E, Hahnefeld A, Fuecker K, Siegert G, Hanefeld M. Relationship between fasting plasma glucose, atherosclerosis risk factors and carotid intima media thickness in non-diabetic individuals.  Diabetologia. 41 706-712 1998; 
    CrossrefPubMedGoogle Scholar
  • 31 Temelkova-Kurktschiev T, Koehler C, Leonhardt W, Schaper F, Henkel E, Siegert G, Hanefeld M. Increased intimal-medial thickness in newly detected type 2 diabetes.  Diabetes Care. 22 333-338 1999; 
    CrossrefPubMedGoogle Scholar
  • 32 UK Prospective Diabetes Study (UKPDS) Group . Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34).  The Lancet. 352 854-865 1998; 
    CrossrefPubMedGoogle Scholar
  • 33 UK Prospective Diabetes Study (UKPDS) Group . Intensive blood-glucose control with sulfonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33).  The Lancet. 352 837-853 1998; 
    CrossrefPubMedGoogle Scholar

1 Data are mean ± SEM. Values are shown after sex adjustment

2 Data are mean ± SEM. Variables are adjusted for sex

T. Temelkova-KurktschievMD 

Institute and Outpatient Clinic of Metabolic Research

University Clinic ``C. G. Carus'' of Technical University Dresden

Fetscher Str. 74

D-01307 Dresden

Phone: +49-03 51-4 58 33 10

Fax: +49-03 51-4 58 53 24

      >