Xuejuan Ning1, Ning Ding1, Shoshana H Ballew1, Caitlin W Hicks2, Josef Coresh1, Elizabeth Selvin1, James Pankow3, Weihong Tang3, Kunihiro Matsushita4. 1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 2. Department of Surgery, Johns Hopkins University School of Medicine, MD, USA. 3. University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, MN, USA. 4. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: kuni.matsushita@jhu.edu.
Abstract
BACKGROUND AND AIMS: We aimed at comprehensively evaluate the independent association of diabetes and its duration with incident abdominal aortic aneurysm (AAA) and aortic diameter. METHODS AND RESULTS: We prospectively studied incident AAA according to baseline glycemic status (diabetes, prediabetes, normal glycemia) in 13,116 ARIC participants (1990-1992) and the time-varying exposure of duration post incident diabetes in 11,675 participants (1987-1989) using Cox models. Additionally, we cross-sectionally explored ultrasound-based abdominal aortic diameter by glycemic status and cumulative duration of diabetes in 4710 participants (2011-2013) using linear regression models. Over ~20 years of follow-up, diabetes (vs. normal glycemia) at baseline was independently associated with lower AAA risk (489 cases) (hazard ratio: 0.71 [95%CI 0.51-0.99]), especially after 10 years (hazard ratio: 0.58 [0.38-0.87]). Prediabetes did not demonstrate an independent association. The inverse association was more evident with longer duration of diabetes (p for trend = 0.045), with 30-50% lower risk in eight years after diabetes diagnosis. The cross-sectional analysis demonstrated smaller aortic diameters with longer duration of diabetes (e.g., -0.76 mm [-1.24, -0.28] in diabetes with 8-12 years) compared to non-diabetes, whereas prediabetes consistently showed nominally greater diameter. CONCLUSIONS: Diabetes, especially with longer duration, but not prediabetes, was independently associated with lower risk of AAA and smaller aortic diameter. Our findings suggest that long lasting clinical hyperglycemia plays an important role in the reduced AAA risk, and the reduced aortic diameter may be a structural mechanism behind this paradoxical association.
BACKGROUND AND AIMS: We aimed at comprehensively evaluate the independent association of diabetes and its duration with incident abdominal aortic aneurysm (AAA) and aortic diameter. METHODS AND RESULTS: We prospectively studied incident AAA according to baseline glycemic status (diabetes, prediabetes, normal glycemia) in 13,116 ARIC participants (1990-1992) and the time-varying exposure of duration post incident diabetes in 11,675 participants (1987-1989) using Cox models. Additionally, we cross-sectionally explored ultrasound-based abdominal aortic diameter by glycemic status and cumulative duration of diabetes in 4710 participants (2011-2013) using linear regression models. Over ~20 years of follow-up, diabetes (vs. normal glycemia) at baseline was independently associated with lower AAA risk (489 cases) (hazard ratio: 0.71 [95%CI 0.51-0.99]), especially after 10 years (hazard ratio: 0.58 [0.38-0.87]). Prediabetes did not demonstrate an independent association. The inverse association was more evident with longer duration of diabetes (p for trend = 0.045), with 30-50% lower risk in eight years after diabetes diagnosis. The cross-sectional analysis demonstrated smaller aortic diameters with longer duration of diabetes (e.g., -0.76 mm [-1.24, -0.28] in diabetes with 8-12 years) compared to non-diabetes, whereas prediabetes consistently showed nominally greater diameter. CONCLUSIONS:Diabetes, especially with longer duration, but not prediabetes, was independently associated with lower risk of AAA and smaller aortic diameter. Our findings suggest that long lasting clinical hyperglycemia plays an important role in the reduced AAA risk, and the reduced aortic diameter may be a structural mechanism behind this paradoxical association.
Authors: Nathan K Itoga; Kara A Rothenberg; Paola Suarez; Thuy-Vy Ho; Matthew W Mell; Baohui Xu; Catherine M Curtin; Ronald L Dalman Journal: J Vasc Surg Date: 2018-09-06 Impact factor: 4.268
Authors: F A Lederle; G R Johnson; S E Wilson; E P Chute; F N Littooy; D Bandyk; W C Krupski; G W Barone; C W Acher; D J Ballard Journal: Ann Intern Med Date: 1997-03-15 Impact factor: 25.391
Authors: Peter T Campbell; Christina C Newton; Alpa V Patel; Eric J Jacobs; Susan M Gapstur Journal: Diabetes Care Date: 2012-06-14 Impact factor: 19.112