Subclinical atherosclerosis is inversely associated with gray matter volume in african americans with type 2 diabetes

Barry I. Freedman, Jasmin Divers, Christopher T. Whitlow, Donald W. Bowden, Nicholette D. Palmer, S. Carrie Smith, Jianzhao Xu, Thomas C. Register, J. Jeffrey Carr, Benjamin C. Wagner, Jeff D. Williamson, Kaycee M. Sink, Joseph A Maldjian

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE Relative to European Americans, African Americans manifest lower levels of computed tomography-based calcified atherosclerotic plaque (CP), a measure of subclinical cardiovascular disease (CVD). Potential relationships between CP and cerebral structure are poorly defined in the African American population. We assessed associations among glycemic control, inflammation, and CP with cerebral structure on MRI and with cognitive performance in 268 high-risk African Americans with type 2 diabetes. RESEARCH DESIGN AND METHODS Associations among hemoglobin A1c (HbA1c), C-reactive protein (CRP), and CP in coronary arteries, carotid arteries, and the aorta with MRI volumetric analysis (white matter volume, gray matter volume [GMV], cerebrospinal fluid volume, and white matter lesion volume) were assessed using generalized linear models adjusted for age, sex, African ancestry proportion, smoking, BMI, use of statins, HbA1c, hypertension, and prior CVD. RESULTS Participants were 63.4% female with mean (SD) age of 59.8 years (9.2), diabetes duration of 14.5 years (7.6), HbA1cof 7.95% (1.9), estimated glomerular filtration rate of 86.6 mL/min/1.73 m2(24.6), and coronary artery CP mass score of 215 mg (502). In fully adjusted models, GMV was inversely associated with coronary artery CP (parameter estimate [β] 20.47 [SE 0.15], P = 0.002; carotid artery CP (β21.92 [SE 0.62], P = 0.002; and aorta CP [β20.10 [SE 0.03] P = 0.002),whereas HbA1c and CRP did not associate with cerebral volumes. Coronary artery CP also associated with poorer global cognitive function on the Montreal Cognitive Assessment. CONCLUSIONS Subclinical atherosclerosis was associated with smaller GMV and poorer cognitive performance in African Americans with diabetes. Cardioprotective strategies could preserve GMV and cognitive function in high-risk African Americans with diabetes.

Original languageEnglish (US)
Pages (from-to)2158-2165
Number of pages8
JournalDiabetes Care
Volume38
Issue number11
DOIs
StatePublished - Nov 1 2015

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Atherosclerotic Plaques
African Americans
Type 2 Diabetes Mellitus
Atherosclerosis
Coronary Vessels
Hemoglobin C
Carotid Arteries
C-Reactive Protein
Cognition
Aorta
Cardiovascular Diseases
Gray Matter
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Glomerular Filtration Rate
Cerebrospinal Fluid
Linear Models
Hemoglobins
Smoking
Tomography
Hypertension

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Subclinical atherosclerosis is inversely associated with gray matter volume in african americans with type 2 diabetes. / Freedman, Barry I.; Divers, Jasmin; Whitlow, Christopher T.; Bowden, Donald W.; Palmer, Nicholette D.; Smith, S. Carrie; Xu, Jianzhao; Register, Thomas C.; Carr, J. Jeffrey; Wagner, Benjamin C.; Williamson, Jeff D.; Sink, Kaycee M.; Maldjian, Joseph A.

In: Diabetes Care, Vol. 38, No. 11, 01.11.2015, p. 2158-2165.

Research output: Contribution to journalArticle

Freedman, BI, Divers, J, Whitlow, CT, Bowden, DW, Palmer, ND, Smith, SC, Xu, J, Register, TC, Carr, JJ, Wagner, BC, Williamson, JD, Sink, KM & Maldjian, JA 2015, 'Subclinical atherosclerosis is inversely associated with gray matter volume in african americans with type 2 diabetes', Diabetes Care, vol. 38, no. 11, pp. 2158-2165. https://doi.org/10.2337/dc15-1035
Freedman, Barry I. ; Divers, Jasmin ; Whitlow, Christopher T. ; Bowden, Donald W. ; Palmer, Nicholette D. ; Smith, S. Carrie ; Xu, Jianzhao ; Register, Thomas C. ; Carr, J. Jeffrey ; Wagner, Benjamin C. ; Williamson, Jeff D. ; Sink, Kaycee M. ; Maldjian, Joseph A. / Subclinical atherosclerosis is inversely associated with gray matter volume in african americans with type 2 diabetes. In: Diabetes Care. 2015 ; Vol. 38, No. 11. pp. 2158-2165.
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abstract = "OBJECTIVE Relative to European Americans, African Americans manifest lower levels of computed tomography-based calcified atherosclerotic plaque (CP), a measure of subclinical cardiovascular disease (CVD). Potential relationships between CP and cerebral structure are poorly defined in the African American population. We assessed associations among glycemic control, inflammation, and CP with cerebral structure on MRI and with cognitive performance in 268 high-risk African Americans with type 2 diabetes. RESEARCH DESIGN AND METHODS Associations among hemoglobin A1c (HbA1c), C-reactive protein (CRP), and CP in coronary arteries, carotid arteries, and the aorta with MRI volumetric analysis (white matter volume, gray matter volume [GMV], cerebrospinal fluid volume, and white matter lesion volume) were assessed using generalized linear models adjusted for age, sex, African ancestry proportion, smoking, BMI, use of statins, HbA1c, hypertension, and prior CVD. RESULTS Participants were 63.4{\%} female with mean (SD) age of 59.8 years (9.2), diabetes duration of 14.5 years (7.6), HbA1cof 7.95{\%} (1.9), estimated glomerular filtration rate of 86.6 mL/min/1.73 m2(24.6), and coronary artery CP mass score of 215 mg (502). In fully adjusted models, GMV was inversely associated with coronary artery CP (parameter estimate [β] 20.47 [SE 0.15], P = 0.002; carotid artery CP (β21.92 [SE 0.62], P = 0.002; and aorta CP [β20.10 [SE 0.03] P = 0.002),whereas HbA1c and CRP did not associate with cerebral volumes. Coronary artery CP also associated with poorer global cognitive function on the Montreal Cognitive Assessment. CONCLUSIONS Subclinical atherosclerosis was associated with smaller GMV and poorer cognitive performance in African Americans with diabetes. Cardioprotective strategies could preserve GMV and cognitive function in high-risk African Americans with diabetes.",
author = "Freedman, {Barry I.} and Jasmin Divers and Whitlow, {Christopher T.} and Bowden, {Donald W.} and Palmer, {Nicholette D.} and Smith, {S. Carrie} and Jianzhao Xu and Register, {Thomas C.} and Carr, {J. Jeffrey} and Wagner, {Benjamin C.} and Williamson, {Jeff D.} and Sink, {Kaycee M.} and Maldjian, {Joseph A}",
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T1 - Subclinical atherosclerosis is inversely associated with gray matter volume in african americans with type 2 diabetes

AU - Freedman, Barry I.

AU - Divers, Jasmin

AU - Whitlow, Christopher T.

AU - Bowden, Donald W.

AU - Palmer, Nicholette D.

AU - Smith, S. Carrie

AU - Xu, Jianzhao

AU - Register, Thomas C.

AU - Carr, J. Jeffrey

AU - Wagner, Benjamin C.

AU - Williamson, Jeff D.

AU - Sink, Kaycee M.

AU - Maldjian, Joseph A

PY - 2015/11/1

Y1 - 2015/11/1

N2 - OBJECTIVE Relative to European Americans, African Americans manifest lower levels of computed tomography-based calcified atherosclerotic plaque (CP), a measure of subclinical cardiovascular disease (CVD). Potential relationships between CP and cerebral structure are poorly defined in the African American population. We assessed associations among glycemic control, inflammation, and CP with cerebral structure on MRI and with cognitive performance in 268 high-risk African Americans with type 2 diabetes. RESEARCH DESIGN AND METHODS Associations among hemoglobin A1c (HbA1c), C-reactive protein (CRP), and CP in coronary arteries, carotid arteries, and the aorta with MRI volumetric analysis (white matter volume, gray matter volume [GMV], cerebrospinal fluid volume, and white matter lesion volume) were assessed using generalized linear models adjusted for age, sex, African ancestry proportion, smoking, BMI, use of statins, HbA1c, hypertension, and prior CVD. RESULTS Participants were 63.4% female with mean (SD) age of 59.8 years (9.2), diabetes duration of 14.5 years (7.6), HbA1cof 7.95% (1.9), estimated glomerular filtration rate of 86.6 mL/min/1.73 m2(24.6), and coronary artery CP mass score of 215 mg (502). In fully adjusted models, GMV was inversely associated with coronary artery CP (parameter estimate [β] 20.47 [SE 0.15], P = 0.002; carotid artery CP (β21.92 [SE 0.62], P = 0.002; and aorta CP [β20.10 [SE 0.03] P = 0.002),whereas HbA1c and CRP did not associate with cerebral volumes. Coronary artery CP also associated with poorer global cognitive function on the Montreal Cognitive Assessment. CONCLUSIONS Subclinical atherosclerosis was associated with smaller GMV and poorer cognitive performance in African Americans with diabetes. Cardioprotective strategies could preserve GMV and cognitive function in high-risk African Americans with diabetes.

AB - OBJECTIVE Relative to European Americans, African Americans manifest lower levels of computed tomography-based calcified atherosclerotic plaque (CP), a measure of subclinical cardiovascular disease (CVD). Potential relationships between CP and cerebral structure are poorly defined in the African American population. We assessed associations among glycemic control, inflammation, and CP with cerebral structure on MRI and with cognitive performance in 268 high-risk African Americans with type 2 diabetes. RESEARCH DESIGN AND METHODS Associations among hemoglobin A1c (HbA1c), C-reactive protein (CRP), and CP in coronary arteries, carotid arteries, and the aorta with MRI volumetric analysis (white matter volume, gray matter volume [GMV], cerebrospinal fluid volume, and white matter lesion volume) were assessed using generalized linear models adjusted for age, sex, African ancestry proportion, smoking, BMI, use of statins, HbA1c, hypertension, and prior CVD. RESULTS Participants were 63.4% female with mean (SD) age of 59.8 years (9.2), diabetes duration of 14.5 years (7.6), HbA1cof 7.95% (1.9), estimated glomerular filtration rate of 86.6 mL/min/1.73 m2(24.6), and coronary artery CP mass score of 215 mg (502). In fully adjusted models, GMV was inversely associated with coronary artery CP (parameter estimate [β] 20.47 [SE 0.15], P = 0.002; carotid artery CP (β21.92 [SE 0.62], P = 0.002; and aorta CP [β20.10 [SE 0.03] P = 0.002),whereas HbA1c and CRP did not associate with cerebral volumes. Coronary artery CP also associated with poorer global cognitive function on the Montreal Cognitive Assessment. CONCLUSIONS Subclinical atherosclerosis was associated with smaller GMV and poorer cognitive performance in African Americans with diabetes. Cardioprotective strategies could preserve GMV and cognitive function in high-risk African Americans with diabetes.

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