kjhp Korean Journal of Health Promotion Korean J Health Promot 2234-2141 2093-5676 The Korean Society of Health Promotion and Disease Prevention 10.15384/kjhp.2015.15.2.47 kjhp-15-47 Original Article 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 RyuYeongju 1 ParkYoungjin 1 YeByeong Jin 2 Departments of Family Medicine, Dong-A University College of Medicine, Busan, Korea Occupational 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 122015 19122015 152 4753 09112014 22042015 Copyright © 2015 The Korean Society of Health Promotion and Disease Prevention 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. 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.

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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.

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

Carotid artery intima media thickness according to gender and smoking status

Variables (n) Max CCAa P
Male Male (225) 0.694±0.275
Female (111) 0.614±0.233 0.007b
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 0.394c
Male Never smoker (74) 0.708±0.269
Smoker with ex smoker (151) 0.688±0.278 0.603b
Female Never smoker (105) 0.622±0.234
Smoker with ex smoker (6) 0.450±0.104 0.077b
Total (336)

Abbreviation: Max CCA, maximum common carotid artery.

Values are presented as mean±SD.

Calculated by t-test.

Calculated by ANOVA.

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.

Correlation coefficient and P-value from bivariate correlation analysis.

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 0.271b
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 0.296b
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.

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

P<0.05.