Association between markers of glycemia and carotid intima-media thickness: the MARK study

BMC Cardiovasc Disord. 2016 Oct 28;16(1):203. doi: 10.1186/s12872-016-0380-6.


Background: Carotid intima-media thickness (C-IMT) is a reliable predictor of cardiovascular events. We Investigated the relationship between markers of glycemia and C-IMT in intermediate-risk cardiovascular patients.

Methods: This study analyzed 427 subjects, aged 35 to 74 years (mean, 60.3 ± 8.5 years), 55 % women, enrolled into the MARK study. Including 231 subjects defined as normal glucose, 104 subjects classified as prediabetes and 92 with type 2 diabetes mellitus. Carotid ultrasound was used to measure C-IMT and the presence of plaques. Fasting plasma glucose (mg/dl) and glycated hemoglobin (%) (HbA1c) were measured using standard enzymatic automated methods. Postprandial glucose (mg/dl) was self-measured by patients at home 2 h after meals (breakfast, lunch and dinner) for 1 day.

Results: The C-IMT shows a positive correlation with fasting plasma glucose, postprandial glucose and HbA1c. Multiple linear regression analysis showed a positive association between HbA1c and C-IMT, with a 0.016 mm and 0.019 mm increase in mean and maximum C-IMT per 1 % increase in HbA1c. In addition, an association between fasting plasma glucose and C-IMT was found with an increase of 0.004 and 0.005 mm in mean and maximum C-IMT per 10 mg/dl in fasting plasma glucose. We also observed a graded association between fasting plasma glucose, postprandial glucose and HbA1c and the presence of carotid target organ damage (TOD), with an odds ratio of 1.013, 1.010 and 1.425, respectively.

Conclusion: The results of this study suggest that the fasting plasma glucose and HbA1c, but not postprandial glucose, are associated with C-IMT media and maximum. The patients who present with a metabolic glucose alteration have more risk of developing carotid TOD.

Trial registration:; Identifier: NCT01428934 .

Keywords: Fasting plasma glucose; Glycosylated hemoglobin; Intima-media thickness; Postprandial glucose.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Biomarkers / blood
  • Blood Glucose / metabolism*
  • Cardiovascular Diseases / blood*
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / etiology
  • Carotid Arteries
  • Carotid Intima-Media Thickness*
  • Cross-Sectional Studies
  • Female
  • Follow-Up Studies
  • Forecasting*
  • Glucose Tolerance Test
  • Glycated Hemoglobin A / metabolism*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Prediabetic State / blood*
  • Prediabetic State / complications
  • Prediabetic State / diagnosis
  • Prevalence
  • Risk Factors
  • Spain / epidemiology


  • Biomarkers
  • Blood Glucose
  • Glycated Hemoglobin A

Associated data