Thoracic aortic calcification across the clinical dysglycemic continuum in a large Asian population free of cardiovascular symptoms

Abstract

Thoracic aortic calcification (TAC) is tightly linked to pathological atherosclerosis and associated with certain cardiovascular diseases. While diabetes mellitus (DM) is known as a coronary heart disease equivalent, we examined the presence of TAC across the dysglycemic spectrum of diabetes mellitus (DM). We consecutively studied 3003 asymptomatic ethnic Asians underwent annual cardiovacular health survey, and further categorized them into: 1) 1760 normo-glycemic, 2) 968 pre-diabetic, and 3) 274 overt DM based on dysglycemic indices and medical histories. Several TAC parameters were assessed using non-contrast multi-detector computed tomography (MDCT), and related to dysglycemic indices or diabetes mellitus status. A remarkably graded increases of adjusted total TAC calcium burden, volume and density were seen across Non-diabetes, Pre-diabetes, and diabetes mellitus categories and positively correlated with all dysglycemic profiles (all p<0.001). Multi-variate logistic and linear regression models demonstrated independent associations between greater TAC density and all dysglycemic indices (Coef: 2.5, 1.4, 6.8 for fasting, postprandial sugar and HbA1c) and diabetes mellitus status (all p<0.05). Furthermore, Receiver-operating characteristic curves (ROC) showed fasting sugar and postprandial sugar set at 103mg/dL and 111mg/dL, separately, with HbA1c set at 5.8% all predict the presence of aortic calcification. Dysglycemic status, even without overt diabetes mellitus, were tighly linked to subclinical, pathological thoracic aortic calcification.

Fig 1. TAC, total plaque burden and mean density of plaques across dysglycemic categories.

The adjusted mean values of Agaston score (TAC), total plaque volume and mean density of plaques across fasting (AC), post-prandial sugar (PC) and HbA1c categories for normo-glycemic (Group 1), pre-diabetes (Group 2), diabetes (Group 3) based on current study defined criteria of both biochemical cut-offs and history. Additionally, we further categorized those study participants with known diabetes mellitus history or known medication usage as Group 4, regardless of biochemical information. Group 4 may indicate a specific group with longstanding diabetes or diabetic subjects with chronicity. 1: Group 1, 2: Group 2, 3: Group 3, and 4: Group 4.

Fig 2. Hypothetical scheme of the pathophysiology of dysglycemic continuum.

Hypothetical scheme for the pathophysiology of dysglycemic continuum of micro-, macrovacular complications and findings of medial layer calcification of thoracic aorta. Arterial calcification may serve as an alternative, clinical early marker of vascular complications in dysglycemic subjects based on current study.