4.3 THE EFFECT OF GLYCAEMIC STATE TRANSITION ON ACCELERATED AORTIC STIFFENING: A LONGITUDINAL STUDY IN THE WHITEHALL II COHORT

Abstract

In 4,759 participants from the Whitehall II study, we examined the impact of glycaemic history on aortic stiffening. Assessment of aortic stiffness by carotid-femoral pulse wave velocity (PWV) was performed twice with a 4 year interval (2007–2009 and 2012–2013). At the first aortic stiffness assessment and 5 years earlier (2002–2004 and 2007–2009 respectively), participants were categorised into 3 groups based on measurements of fasting plasma glucose (FPG), 2-hour plasma glucose (2hPG), and HbA1c: normoglycaemia, dysglycaemia and type 2 diabetes. The impact of 5-year glycaemic state transition on PWV and PWV changes was analysed by mixed effect models adjusting for relevant confounders. In participants who had normoglycaemia on FPG, 2hPG and HbA1c on both examinations, PWV was 8.3 m/s at baseline and increased by 0.4 m/s during 4 years. Those who progressed to dysglycaemia had a 0.3 m/s (95% CI: 0.1;0.5) steeper increase in PWV compared with stable normoglycaemia, whereas those who progressed to diabetes did not have a statistical significantly steeper increase in PWV (0.1 m/s (95% CI: −0.4; 0.6)). Participants with diabetes at both examinations had a markedly larger increase in PWV of 0.6 m/s (95% CI: 0.3;0.9) compared to participants with stable normoglycaemia. For other glycaemic state combinations there was a tendency towards a steeper increase in PWV compared with stable normoglycaemia, however not statistically significant. These results indicate that people with diabetes or deteriorating dysglycaemia, experience accelerated aortic stiffening; suggesting that prevention of dysglycaemic progression and diabetes may have a beneficial effect on the progression of aortic stiffness.