Post-challenge glucose predicts coronary atherosclerotic progression in non-diabetic, post-menopausal women1

Authors

  • P. B. Mellen,

    1. Division of General Internal Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL and
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  • V. Bittner,

    1. Division of General Internal Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL and
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  • D. M. Herrington

    1. Division of Cardiology, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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  • 1

    Findings from this study were presented at the American Heart Association Scientific Sessions, November 2005, Dallas, TX, USA. Mellen P, Herrington D. Post-challenge glucose—how low should you go?: High–normal 2-h glucose predicts coronary disease progression in post-menopausal women. Circulation 2005; 112: II-820.

: Philip B. Mellen MD MS, Internal Medicine/General Internal Medicine, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA. E-mail: pmellen@wfubmc.edu

Abstract

Aims  We sought to determine whether fasting or post-challenge glucose were associated with progression of coronary atherosclerosis in non-diabetic women.

Methods  We performed a post-hoc analysis of 132 non-diabetic women who underwent 75-g oral glucose tolerance testing. The primary outcome of interest was progression of atherosclerosis determined by baseline and follow-up coronary angiography, a mean of 3.1 ± 0.9 years apart. We analysed the association of change in minimal vessel diameter (ΔMD) by quartile of fasting and post-challenge glucose using mixed models that included adjustment for age, systolic blood pressure, total : high-density lipoprotein cholesterol ratio, current smoking, lipid-lowering and anti-hypertensive medication use and other covariates.

Results  At baseline, participants had a mean age of 65.7 ± 6.7 years and a mean body mass index of 27.9 ± 8.5 kg/m2. Although there were no significant differences in atherosclerotic progression by fasting glucose category (P for trend across quartiles = 0.99), there was a significant inverse association between post-challenge glucose and ΔMD (in mm) (Q1 : 0.01 ± 0.03; Q2 : 0.08 ± 0.03; Q3 : 0.13 ± 0.03; Q4 : 0.11 ± 0.03; P for trend = 0.02).

Conclusions  In post-menopausal women without diabetes, post-challenge glucose predicts angiographic disease progression. These findings suggest that even modest post-challenge hyperglycaemia influences the pathogenesis of atherosclerotic progression.

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