Predictors of Atherosclerosis Progression in African Americans With Type 2 Diabetes

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Bone density and eGFR are linked to calcified atherosclerotic plaque in some diabetes patients.
Bone density and eGFR are linked to calcified atherosclerotic plaque in some diabetes patients.

Among African Americans with type 2 diabetes, lower baseline thoracic and lumbar volumetric bone mineral density (vBMD) and estimated glomerular filtration rate (eGFR) and higher pericardial adipose volumes were associated with increases in calcified atherosclerotic plaque, according to a study published in the Journal of Clinical Endocrinology & Metabolism.1

“The novel finding in this longitudinal study of African Americans with type 2 diabetes is the observation that lower baseline levels of lumbar and thoracic vertebrae vBMD are significantly associated with increases in aorta calcified atherosclerotic plaque over a 5-year period,” researchers wrote. “This finding is novel because African Americans and European Americans have markedly different vitamin D axes, levels of bone mineralization, and urinary calcium handling.”

The researchers recruited 691 African Americans with type 2 diabetes from 2007 to 2010; 43% (n=300) returned for a follow-up examination at approximately 5 years. Half the cohort was female, mean age was 55 years, and baseline HbA1c was 8.1%.

Results showed that both incidence of any calcified atherosclerotic plaque and quantity of calcified atherosclerotic plaque, defined as change in calcium mass over time, increased over time in all 3 vascular beds (all P<.0001). An inverse relationship was noted between both baseline lumbar vBMD and thoracic vBMD and change in aorta calcified atherosclerotic plaque. However, this was not the case for change in coronary or carotid artery calcified atherosclerotic plaque.

In a fully-adjusted model, lower baseline lumbar vBMD was associated with an increase in aorta CP (P=.006). Similarly, lower baseline thoracic vBMD associated with an increase in aorta calcified atherosclerotic plaque (P=.005). Effect sizes were consistent for both men and women, but the effect was slightly reduced after a sensitivity analysis that excluded 23 participants who were taking steroids or bisphosphonates.

The researchers also determined that lower baseline eGFR was associated with increased progression of carotid artery calcified atherosclerotic plaque (P=.0004). Higher baseline pericardial fat was associated with increased progression of coronary artery calcified atherosclerotic plaque (P=.001) and aorta calcified atherosclerotic plaque (P=.0006). Changes in pericardial adipose volume, eGFR, or baseline level or change in the levels of HbA1c, vitamin D and mineral metabolites, and C-reactive protein were not associated with calcified atherosclerotic plaque changes in any vascular bed.

Disclosures: The researchers report no financial disclosures.

References

  1. Wagenknecht LE, Divers J, Register TC, et al. Bone mineral density and progression of subclinical atherosclerosis in African Americans with type 2 diabetes. J Clin Endocrinol Metab. 2016. doi:10.1210/jc.2016-1934.
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