PLASMA GLUCOSE WITHIN NON-DIABETIC RANGE IS ASSOCIATED WITH NOVEL BIOMARKERS OF CARDIOMETABOLIC RISK IN ELSA-BRAZIL
METHODS: 998 adults, both sexes, 35-54 years without diabetes or cardiovascular disease were classified as normoglycemic or with pre-diabetes. Traditional risk factors and markers of atherogenesis and proportions of individuals with coronary calcium score (CAC) different from zero were compared across plasma glucose levels.
RESULTS: From 998 individuals (55% women), 66% had the diagnosis of pre-diabetes. Pre-diabetic group had higher mean values of traditional CV risk factors, although all these were within the normal range. The pre-diabetes status showed greater medians (interquartile intervals) of TGF-β1 [16.4 (8.1 – 26.5) versus 12.2 (6.4 – 22.3) pg/mL, p<0.001] and E-selectin [78.1 (45.5 – 121.6) versus 68.0 (43.6 – 101.9) ng/mL, p0.02] and lower concentration of MCP-1 [32.8 (18.7 – 54.9) versus 35.7 (21.2 – 57.2) pg/mL, p0.05] than the normal group. Mean values of IL-10, MCP-1 and adiponectin were progressively lower across plasma glucose categories (3 categories: 1:≤99; 2:100-110; 3:≥110mg/dL) while TGF-β1 and E-selectin increased. TGF-β1 maintained independently associated with pre-diabetes after adjustment for age, sex, waist circumference and fasting insulin. The proportion of participants with CAC different from zero was greater in the pre-diabetic group compared to the other group (respectively, 15.6% versus 7.5%, p<0.001), and increased across the categories of fasting plasma glucose levels: 7.5% (≤99mg/dL), 13.6% (from 100-110) and 21.7% (≥110mg/dL) (p < 0.001). The CAC different from zero was correlated to pre-diabetes status and fasting plasma glucose levels, but this association was attenuated when BMI entered in the models.
CONCLUSIONS: Some markers of atherogenesis are associated with descript elevations of glycemia, precluding alterations in traditional cardiovascular risk factors. TGF-β1 increases concomitant with increments in plasma glucose level – independently of body adiposity – in this large sample of middle-aged adults, may suggest its usefulness in identifying progressive atherogenesis. The role of biomarkers for the prediction of cardiovascular outcomes requires further investigation in longitudinal studies.