Diabetes status modifies the association between carotid intima-media thickness and incident heart failure: The Atherosclerosis Risk in Communities study

Valery S. Effoe, Eric E. McClendon, Carlos J. Rodriguez, Lynne E. Wagenknecht, Gregory W. Evans, Patricia P. Chang, Alain G. Bertoni

Research output: Contribution to journalArticle

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Abstract

Aims Increasing carotid intima-media thickness (CIMT) is associated with incident heart failure (HF). We investigated whether this association differs by diabetes status. Methods We characterized 13,590 Atherosclerosis Risk in Communities Study participants free of baseline HF into normal fasting glucose (NFG, glucose <100 mg/dl), impaired fasting glucose (IFG, glucose 100–125 mg/dl), and type 2 diabetes (T2D, glucose ≥126 mg/dl, self-report, or use of diabetes drugs). CIMT was assessed by B-mode ultrasound. Incident HF was defined using ICD-9 or 10 codes from hospitalizations and death certificates. Cox regression was used to estimate hazard ratios (HR) for incident HF, adjusting for age, sex, race, education, hypertension medication, blood pressure, BMI, waist circumference, HDL, LDL, triglycerides, lipid-lowering medication, smoking, alcohol, serum creatinine, and interim CHD. Results T2D participants had higher mean CIMT (0.79 ± 0.20 mm), compared to IFG (0.75 ± 0.19 mm) and NFG (0.70 ± 0.17 mm) (p < 0.0001). Over 20.6 years of median follow-up, 15% developed HF. Rates of HF (per 1000 person-years) were substantially higher for those with T2D (24.7), compared to IFG (7.7) and NFG (5.8). In adjusted analyses, the CIMT-HF association was significantly modified by diabetes status (Pinteraction = 0.015): for NFG (HR per SD increase in CIMT: 1.27; 95%CI: 1.20–1.34), IFG (HR 1.18; 95%CI: 1.11–1.25) and T2D (HR 1.12; 95%CI: 1.05–1.21). Conclusions CIMT is associated with increased risk of HF, particularly among persons without diabetes. Due to a high absolute risk of HF among adults with T2D, CIMT may be a less reliable predictor.

Original languageEnglish (US)
Pages (from-to)58-66
Number of pages9
JournalDiabetes Research and Clinical Practice
Volume128
DOIs
StatePublished - Jun 1 2017
Externally publishedYes

Fingerprint

Carotid Intima-Media Thickness
Atherosclerosis
Heart Failure
Glucose
International Classification of Diseases
Fasting
Death Certificates
Sex Education
Waist Circumference
Self Report
Type 2 Diabetes Mellitus
Creatinine
Hospitalization
Smoking
Alcohols
Blood Pressure
Hypertension
Lipids

Keywords

  • Carotid intima-media thickness
  • Diabetes mellitus
  • Heart failure
  • Subclinical atherosclerosis

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Diabetes status modifies the association between carotid intima-media thickness and incident heart failure : The Atherosclerosis Risk in Communities study. / Effoe, Valery S.; McClendon, Eric E.; Rodriguez, Carlos J.; Wagenknecht, Lynne E.; Evans, Gregory W.; Chang, Patricia P.; Bertoni, Alain G.

In: Diabetes Research and Clinical Practice, Vol. 128, 01.06.2017, p. 58-66.

Research output: Contribution to journalArticle

Effoe, Valery S. ; McClendon, Eric E. ; Rodriguez, Carlos J. ; Wagenknecht, Lynne E. ; Evans, Gregory W. ; Chang, Patricia P. ; Bertoni, Alain G. / Diabetes status modifies the association between carotid intima-media thickness and incident heart failure : The Atherosclerosis Risk in Communities study. In: Diabetes Research and Clinical Practice. 2017 ; Vol. 128. pp. 58-66.
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abstract = "Aims Increasing carotid intima-media thickness (CIMT) is associated with incident heart failure (HF). We investigated whether this association differs by diabetes status. Methods We characterized 13,590 Atherosclerosis Risk in Communities Study participants free of baseline HF into normal fasting glucose (NFG, glucose <100 mg/dl), impaired fasting glucose (IFG, glucose 100–125 mg/dl), and type 2 diabetes (T2D, glucose ≥126 mg/dl, self-report, or use of diabetes drugs). CIMT was assessed by B-mode ultrasound. Incident HF was defined using ICD-9 or 10 codes from hospitalizations and death certificates. Cox regression was used to estimate hazard ratios (HR) for incident HF, adjusting for age, sex, race, education, hypertension medication, blood pressure, BMI, waist circumference, HDL, LDL, triglycerides, lipid-lowering medication, smoking, alcohol, serum creatinine, and interim CHD. Results T2D participants had higher mean CIMT (0.79 ± 0.20 mm), compared to IFG (0.75 ± 0.19 mm) and NFG (0.70 ± 0.17 mm) (p < 0.0001). Over 20.6 years of median follow-up, 15{\%} developed HF. Rates of HF (per 1000 person-years) were substantially higher for those with T2D (24.7), compared to IFG (7.7) and NFG (5.8). In adjusted analyses, the CIMT-HF association was significantly modified by diabetes status (Pinteraction = 0.015): for NFG (HR per SD increase in CIMT: 1.27; 95{\%}CI: 1.20–1.34), IFG (HR 1.18; 95{\%}CI: 1.11–1.25) and T2D (HR 1.12; 95{\%}CI: 1.05–1.21). Conclusions CIMT is associated with increased risk of HF, particularly among persons without diabetes. Due to a high absolute risk of HF among adults with T2D, CIMT may be a less reliable predictor.",
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T1 - Diabetes status modifies the association between carotid intima-media thickness and incident heart failure

T2 - The Atherosclerosis Risk in Communities study

AU - Effoe, Valery S.

AU - McClendon, Eric E.

AU - Rodriguez, Carlos J.

AU - Wagenknecht, Lynne E.

AU - Evans, Gregory W.

AU - Chang, Patricia P.

AU - Bertoni, Alain G.

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N2 - Aims Increasing carotid intima-media thickness (CIMT) is associated with incident heart failure (HF). We investigated whether this association differs by diabetes status. Methods We characterized 13,590 Atherosclerosis Risk in Communities Study participants free of baseline HF into normal fasting glucose (NFG, glucose <100 mg/dl), impaired fasting glucose (IFG, glucose 100–125 mg/dl), and type 2 diabetes (T2D, glucose ≥126 mg/dl, self-report, or use of diabetes drugs). CIMT was assessed by B-mode ultrasound. Incident HF was defined using ICD-9 or 10 codes from hospitalizations and death certificates. Cox regression was used to estimate hazard ratios (HR) for incident HF, adjusting for age, sex, race, education, hypertension medication, blood pressure, BMI, waist circumference, HDL, LDL, triglycerides, lipid-lowering medication, smoking, alcohol, serum creatinine, and interim CHD. Results T2D participants had higher mean CIMT (0.79 ± 0.20 mm), compared to IFG (0.75 ± 0.19 mm) and NFG (0.70 ± 0.17 mm) (p < 0.0001). Over 20.6 years of median follow-up, 15% developed HF. Rates of HF (per 1000 person-years) were substantially higher for those with T2D (24.7), compared to IFG (7.7) and NFG (5.8). In adjusted analyses, the CIMT-HF association was significantly modified by diabetes status (Pinteraction = 0.015): for NFG (HR per SD increase in CIMT: 1.27; 95%CI: 1.20–1.34), IFG (HR 1.18; 95%CI: 1.11–1.25) and T2D (HR 1.12; 95%CI: 1.05–1.21). Conclusions CIMT is associated with increased risk of HF, particularly among persons without diabetes. Due to a high absolute risk of HF among adults with T2D, CIMT may be a less reliable predictor.

AB - Aims Increasing carotid intima-media thickness (CIMT) is associated with incident heart failure (HF). We investigated whether this association differs by diabetes status. Methods We characterized 13,590 Atherosclerosis Risk in Communities Study participants free of baseline HF into normal fasting glucose (NFG, glucose <100 mg/dl), impaired fasting glucose (IFG, glucose 100–125 mg/dl), and type 2 diabetes (T2D, glucose ≥126 mg/dl, self-report, or use of diabetes drugs). CIMT was assessed by B-mode ultrasound. Incident HF was defined using ICD-9 or 10 codes from hospitalizations and death certificates. Cox regression was used to estimate hazard ratios (HR) for incident HF, adjusting for age, sex, race, education, hypertension medication, blood pressure, BMI, waist circumference, HDL, LDL, triglycerides, lipid-lowering medication, smoking, alcohol, serum creatinine, and interim CHD. Results T2D participants had higher mean CIMT (0.79 ± 0.20 mm), compared to IFG (0.75 ± 0.19 mm) and NFG (0.70 ± 0.17 mm) (p < 0.0001). Over 20.6 years of median follow-up, 15% developed HF. Rates of HF (per 1000 person-years) were substantially higher for those with T2D (24.7), compared to IFG (7.7) and NFG (5.8). In adjusted analyses, the CIMT-HF association was significantly modified by diabetes status (Pinteraction = 0.015): for NFG (HR per SD increase in CIMT: 1.27; 95%CI: 1.20–1.34), IFG (HR 1.18; 95%CI: 1.11–1.25) and T2D (HR 1.12; 95%CI: 1.05–1.21). Conclusions CIMT is associated with increased risk of HF, particularly among persons without diabetes. Due to a high absolute risk of HF among adults with T2D, CIMT may be a less reliable predictor.

KW - Carotid intima-media thickness

KW - Diabetes mellitus

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KW - Subclinical atherosclerosis

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