Glycemic markers and relation with arterial stiffness in Caucasian subjects of the MARK study

PLoS One. 2017 Apr 17;12(4):e0175982. doi: 10.1371/journal.pone.0175982. eCollection 2017.


Background: Effect of prediabetes and normal glucose on arterial stiffness remains controversial. The primary aim of this study was to investigate the relationship of fasting plasma glucose (FPG), postprandial glucose (PG) and glycosylated haemoglobin (HbA1c) with brachial-ankle pulse wave velocity (baPWV) and cardio-ankle vascular index (CAVI) in Caucasian adults. The secondary aim was to analyse this relationship by glycaemic status.

Methods: Cross-sectional study. Setting: Primary care. Participants: 2,233 subjects, 35-74 years. Measures: FPG (mg/dL) and HbA1c (%) of all subjects were measured using standard automated enzymatic methods. PG (mg/dL) was self-measured at home two hours after meals (breakfast, lunch and dinner) for one day using an Accu-chek ® glucometer. CAVI was measured using a VaSera VS-1500® device (Fukuda Denshi), and baPWV was calculated using a validated equation.

Results: CAVI and baPWV values were significantly higher in subjects with diabetes mellitus than in glucose normal and prediabetes groups (p<0.001). FPG, PG and HbA1c were positively associated with CAVI and baPWV. The β regression coefficient for: HbA1c was 0.112 (CI 95% 0.068 to 0.155) with CAVI, 0.266 (CI 95% 0.172 to 0.359) with baPWV; for PG was 0.006 (CI 95% 0.004 to 0.009 and for FPG was 0.005 (CI 95% 0.002 to 0.008) with baPWV; and for PG was 0.002 (CI 95% 0.001 to 0.003) and 0.003 (CI 95% 0.002 to 0.004) with CAVI (p<0.01 in all cases). When analysing by hyperglycaemic status, FPG, PG and HbA1c were positively associated with CAVI and baPWV in subjects with type 2 diabetes mellitus.

Conclusion: FPG, PG and HbA1c show a positive association with CAVI and baPWV, in Caucasian adults with intermediate cardiovascular risk factors. When analysing by hyperglycaemic status, the association is only maintained in subjects with type 2 diabetes mellitus.

Trial registration: Clinical Identifier: NCT01428934. Registered 2 September 2011. Retrospectively registered. Last updated September 8, 2016.

Publication types

  • Clinical Trial
  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Ankle / physiology
  • Ankle Brachial Index / methods
  • Biomarkers / blood*
  • Biomarkers / metabolism
  • Blood Flow Velocity / physiology
  • Blood Glucose / metabolism*
  • Blood Pressure / physiology
  • Cardiovascular Diseases / blood
  • Cardiovascular Diseases / metabolism
  • Cardiovascular Diseases / physiopathology
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / metabolism
  • Diabetes Mellitus, Type 2 / physiopathology
  • European Continental Ancestry Group
  • Female
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Hyperglycemia / blood
  • Hyperglycemia / metabolism
  • Hyperglycemia / physiopathology
  • Male
  • Middle Aged
  • Postprandial Period / physiology*
  • Prediabetic State / blood
  • Prediabetic State / physiopathology
  • Pulse Wave Analysis / methods
  • Risk Factors
  • Vascular Stiffness / physiology*


  • Biomarkers
  • Blood Glucose
  • Glycated Hemoglobin A

Associated data


Grant support

This work was supported by grants from the Spanish Ministry of Science and Innovation (MICINN), the Carlos III Health Institute/European Regional Development Fund (ERDF) (MICINN, ISCIII/FEDER) (Red RedIAPP RD06/0018, Research Groups: RD16/0007/0003, RD16/0007/0004, RD16/0007/0008), the Health Research Fund (PI10/01088, PI10/02077, PI10/02043; PI13/01930), and the Regional Health Management of Castile and León (GRS 635/A/11; GRS 906/B/14).