The Correlation between Hemoglobin A1c and Common Carotid Artery Intima Medial Thickness of Both Genders with Less Than 6.5% HbA1c Based on Ultrasound Measurement

Yeongju Ryu; Youngjin Park; Byeong Jin Ye

doi:10.15384/kjhp.2015.15.2.47

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Ryu, Park, and Ye: The Correlation between Hemoglobin A1c and Common Carotid Artery Intima Medial Thickness of Both Genders with Less Than 6.5% HbA1c Based on Ultrasound Measurement

Original Article

Korean J Health Promot 2015;15(2):47-53.

Published online: 19 December 2015

DOI: https://doi.org/10.15384/kjhp.2015.15.2.47

The Correlation between Hemoglobin A1c and Common Carotid Artery Intima Medial Thickness of Both Genders with Less Than 6.5% HbA1c Based on Ultrasound Measurement

Yeongju Ryu¹, Youngjin Park¹, Byeong Jin Ye²

¹Departments of Family Medicine, Dong-A University College of Medicine, Busan, Korea

²Occupational and Environmental Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea

Corresponding author：Youngjin Park, MD, PhD Department of Family Medicine, Dong-A University Hospital, Dong-A University College of Medicine, 26 Daesingongwon-ro, Seo-gu, Busan 602-715, Korea Tel: +82-51-240-5454, Fax: +82-51-255-8282 E-mail: yjpfm@dau.ac.kr, sh090474@daum.net

Received 9 November 2014 Accepted 22 April 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

The glycemic control in diabetes is well known to arouse a medical risk of macrovascular regions. This study aimed for exploring the relationship between carotid artery intima media thickness (IMT) and the risk triggers of macrovascular diseases in the group of glycated hemoglobin value less than 6.5%.

Methods

The subjects were made of 336 health-check examinees in a university hospital and tested by gly-cated hemoglobin (HbA1c) including ultrasound application on carotid artery IMT to be measured. The relationship between values of HbA1c and carotid artery IMT was reviewed by use of Pearson's correlation, and then influential causes on the carotid artery IMT were analyzed with multiple linear regression models.

Results

Elements like age and fasting plasma glucose were associated with the carotid artery IMT in both men and women. HbA1c, C-reactive protein (CRP) in men and waist to hip ratio (WHR), high-density lipoprotein (HDL)-cholesterol in women showed statistically significant association with the carotid artery IMT. Age and HbA1c were recognized as variables affecting on the carotid artery IMT in men, in contrast, age was only a significant affecting factor in women with regarding various considerations such as fasting plasma glucose, CRP, HDL, WHR and smoking.

Conclusions

Our clinical investigation revealed that HbA1c was associated with the carotid artery IMT in normal and pre-diabetes with HbA1c less than 6.5%. The outcome might suggest preliminary glucose control be monitored and managed in order to detect and regulate the impairment of macrovascular diseases prior to the occurrence of diabetes.

Keywords: Hemoglobin A1c, Carotid arteries, Carotid intima-media thickness, Diabetes mellitus

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Table 1.

Clinical characteristics of participants with HbA1c of less than 6.5%^a

	Male			Female
	HbA1c<5.7% (n=144)	HbA1c≥5.7% (n=81)	P	HbA1c<5.7% (n=81)	HbA1c≥5.7% (n=30)	P
Age, y	48.35±8.85	50.79±8.95	0.050	50.25±9.03	53.84±8.49	0.055
HbA1c, %	5.326±0.21	5.896±0.22	<0.001	5.300±0.24	5.922±0.21	<0.001
FPG, mg/dL	86.00±9.10	92.60±10.89	<0.001	82.67±8.56	97.13±9.80	<0.001
IMT, mm SBP, mmHg	0.653±0.229 122.56±11.37	0.743±0.303 124.05±12.18	0.021 0.357	0.575±0.176 116.75±15.01	0.656±0.231 121.41±17.40	0.047 0.159
DBP, mmHg	76.83±7.82	78.12±8.76	0.257	73.22±9.16	72.59±10.45	0.753
WHR	0.89±0.05	0.91±0.06	0.006	0.822±0.07	0.848±0.05	0.055
BMI, kg/m²	24.62±2.98	26.16±3.70	0.002	22.37±2.96	24.53±4.42	0.015
TC, mg/dL	203.06±31.87	211.72±32.08	0.052	206.53±33.18	212.13±43.77	0.464
TG, mg/dL HDL, mg/dL	133.49±88.07 53.08±12.57	169.40±105.22 49.99±11.82	0.007 0.071	88.94±63.71 62.51±16.81	108.28±56.55 54.47±13.72	0.119 0.018
LDL, mg/dL	122.19±27.09	129.86±27.49	0.044	120.44±29.90	130.69±41.78	0.213
CRP, mg/dL	0.191±0.346	0.148±0.215	0.309	0.100±0.210	0.179±0.364	0.149

Abbreviations: FPG, fasting plama glucose; IMT, intima media thicknessof carotid artery; SBP, systolic blood pressure; DBP, diastolic blood pressure; WHR, waist-hip ratio; BMI, body mass index; TC, total cholesterol; TG, triglyceride; HDL, high-density lipoprotein; LDL, low-density lipoprotein; CRP, C-reactive protein.

^a Values are presented as mean±SD. Statistical significance was determined using Student t-test.

Table 2.

Carotid artery intima media thickness according to gender and smoking status

	Variables (n)	Max CCA^a	P
Male	Male (225)	0.694±0.275
	Female (111)	0.614±0.233	0.007^b
	Never smoker (74)	0.708±0.269
	Quit≥1 yr (52)	0.735±0.337
	Quit<1 yr (12)	0.700±0.332
	Current smoker (87)	0.657±0.223	0.394^c
Male	Never smoker (74)	0.708±0.269
Male	Smoker with ex smoker (151)	0.688±0.278	0.603^b
Female	Never smoker (105)	0.622±0.234
	Smoker with ex smoker (6)	0.450±0.104	0.077^b
	Total (336)

Abbreviation: Max CCA, maximum common carotid artery.

^a Values are presented as mean±SD.

^b Calculated by t-test.

^c Calculated by ANOVA.

Table 3.

Associations between affecting factors and carotid artery intima media thickness for individuals with HbA1c of less than 6.5%^a

	Male (225)		Female (111)
	Correlation	P	Correlation	P
Age	0.465	<0.001	0.460	<0.001
HbA1c	0.271	<0.001	0.075	0.421
FPG	0.131	0.047	0.316	<0.001
SBP	0.093	0.164	0.051	0.591
DBP	0.049	0.468	0.039	0.682
WHR	0.086	0.191	0.197	0.032
BMI	0.019	0.775	0.148	0.111
TC	0.050	0.455	-0.056	0.557
TG	-0.044	0.509	0.065	0.484
HDL	-0.021	0.755	-0.242	0.008
LDL	0.045	0.500	0.081	0.386
CRP	0.168	0.011	0.010	0.917

Abbreviations: FPG, fasting plama glucose; SBP, systolic blood pressure; DBP, diastolic blood pressure; WHR, waist-hip ratio; BMI, body mass index; TC, total cholesterol; TG, triglyceride; HDL, high-density lipoprotein; LDL, low-density lipoprotein; CRP, C-reactive protein.

^a Correlation coefficient and P-value from bivariate correlation analysis.

Table 4.

Multiple linear regression for affecting factors on carotid artery intima media thickness for individuals with HbA1c of less than 6.5%^a

		β±SE	Standardized β	P	R²
Male	Age	0.012±0.002	0.424	<0.001	0.271^b
	HbA1c	0.145±0.051	0.182	0.004
	HDL	0.000±0.001	0.021	0.730
	FPG	0.002±0.002	0.070	0.287
	WHR Smoking	-0.263±0.325 -0.013±0.034	-0.052 -0.022	0.419 0.702
	CRP	0.062±0.052	0.072	0.242
Female	Age	0.009±0.002	0.402	<0.001	0.296^b
	HbA1c	-0.105±0.057	-0.175	0.068
	HDL	-0.002±0.001	-0.165	0.061
	FPG WHR	0.004±0.002 0.097±0.310	0.189 0.027	0.070 0.755
	Smoking	-0.122±0.088	-0.116	0.167
	CRP	-0.022±0.077	-0.025	0.773
Abbreviations: SE, standard errors; HDL, high-density lipoprotein; FPG, fasting plama glucose; WHR, waist-hip ratio; CRP, C-reactive protein.

^a The model is adjusted for age, HbA1c, fasting plasma glucose, c-reactive protein, high-density lipoprotein cholesterol, waist to hip ratio and smoking.

^b P<0.05.

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