Complexity of the relation between hemoglobin A1C, diabetes mellitus, and progression of coronary narrowing in  postmenopausal women. 

 -  2013 
<br/><br/>Available online from MWHC library: 1995 -  present, Available in print through MWHC library: 1999 -  2006 
<br/><br/> The aim of this study was to assess the effect of  diabetes mellitus (DM) and glycosylated hemoglobin (HbA1c)  on the progression of atherosclerosis in postmenopausal  women. A retrospective analysis of the Women's Angiographic  and Vitamin and Estrogen (WAVE) trial, a multicenter  randomized trial on progression of atherosclerosis in  postmenopausal women, was performed. Baseline and follow-up  angiography was performed in 320 women. Minimum luminal  diameter and average luminal diameter at baseline and  follow-up were measured in 1,735 coronary segments.  Measurements and adverse events were grouped on the basis of  history of DM and HbA1c. DM was associated with more total  cardiac events but with similar rates of death or myocardial  infarction. There were greater reductions in minimum luminal  diameter and average luminal diameter in segments from  patients with known DM (p <0.001) and with a baseline HbA1c  >=6.5% (p= 0.002 and p= 0.004, respectively). The greater  reductions in minimum luminal diameter and average luminal  diameter in the higher HbA1c strata were only in patients  with known DM. More new lesions, however, appeared with  baseline HbA1c >=5.7%, irrespective of a history of DM. In  conclusion, the relation between DM and the progression of  coronary narrowing in postmenopausal women is complex.  Clinically apparent DM, not elevated HbA1c alone, appears to  promote the progression of established coronary lesions even  in HbA1c ranges diagnostic of pre-DM and DM. This raises the  possibility that coronary narrowing of existing stenosis in  women with DM may be due to negative remodeling, a complex  process that might be less dependent on hyperglycemia than  new lesion formation. Copyright  2013 Elsevier Inc. All  rights reserved. 
<br/><br/><br/>English 
<br/><br/><label>ISSN: </label>0002-9149 
<br/><br/><label>Subjects--Topical Terms: </label><br/>*Coronary Artery Disease/me [Metabolism]<br/>*Diabetes Mellitus/me [Metabolism]<br/>*Hemoglobin A, Glycosylated/me [Metabolism]<br/>*Postmenopause<br/>Aged<br/>Canada<br/>Disease Progression<br/>Female<br/>Humans<br/>Middle Aged<br/>Ovariectomy<br/>Retrospective Studies<br/>Risk Factors<br/>United States
<br/><br/><label>Subjects--Geographic Terms: </label><br/>MedStar Health Research Institute<br/>MedStar Heart & Vascular Institute
<br/><br/><label>Index Terms--Function: </label><br/>Journal Article<br/>Multicenter Study<br/>Randomized Controlled Trial