Sagittal abdominal diameter is a more independent measure compared with waist circumference to predict arterial stiffness in subjects with type 2 diabetes--a prospective observational cohort study

Elsa M Dahlén, Niclas Bjarnegård, Toste Länne, Fredrik H Nystrom, Carl J Ostgren, Elsa M Dahlén, Niclas Bjarnegård, Toste Länne, Fredrik H Nystrom, Carl J Ostgren

Abstract

Background: Anthropometric measurements are useful in clinical practice since they are non-invasive and cheap. Previous studies suggest that sagittal abdominal diameter (SAD) may be a better measure of visceral fat depots. The aim of this study was to prospectively explore and compare how laboratory and anthropometric risk markers predicted subclinical organ damage in 255 patients, with type 2 diabetes, after four years.

Methods: Baseline investigations were performed in 2006 and were repeated at follow-up in 2010. Carotid intima-media thickness (IMT) was evaluated by ultrasonography and aortic pulse wave velocity (PWV) was measured with applanation tonometry over the carotid and femoral arteries at baseline and at follow-up in a cohort of subjects with type 2 diabetes aged 55-65 years old.

Results: There were significant correlations between apolipoprotein B (apoB) (r = 0.144, p = 0.03), C - reactive protein (CRP) (r = 0.172, p = 0.009) at baseline and IMT measured at follow-up. After adjustment for sex, age, treatment with statins and Hba1c, the associations remained statistically significant. HbA1c, total cholesterol or LDL-cholesterol did not correlate to IMT at follow-up. Baseline body mass index (BMI) (r = 0.130, p = 0.049), waist circumference (WC) (r = 0.147, p = 0.027) and sagittal Abdominal Diameter (SAD) (r = 0.184, p = 0.007) correlated to PWV at follow-up. Challenged with sex, SBP and HbA1c, the association between SAD, not WC nor BMI, and PWV remained statistically significant (p = 0.036). In a stepwise linear regression, entering both SAD and WC, the association between SAD and PWV was stronger than the association between WC and PWV.

Conclusions: We conclude that apoB and CRP, but not LDL-cholesterol predicted subclinical atherosclerosis. Furthermore, SAD was more independent in predicting arterial stiffness over time, compared with WC, in middle-aged men and women with type 2 diabetes.

Trial registration: ClinicalTrials.gov NCT01049737.

Figures

Figure 1
Figure 1
Correlation between baseline characteristics 2006 and IMT and PWV 2010. LDL; low-density lipoprotein, nonHDL; non high-density lipoprotein, apoB; apolipoprotein B, CRP; c-reactive protein, SBP; systolic blood pressure, BMI; body mass index; SAD; sagittal abdominal diameter, WC; waist circumference. * Correlation significant at p < 0.05, ** correlation significant at p < 0.01.
Figure 2
Figure 2
Relation between changes in SAD (x-axis) and WC (y-axis) after 4 years from the baseline investigation both measured in cm.

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