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Post-Challenge Hyperglycemia in Older Adults Is Associated with Increased Cardiovascular Risk Profile

The Institute of Aging Research (J.P.C., V.T., N.B.), Diabetes Research and Training Center (J.P.C., H.S., M.R., S.G., G.T., N.B.), and Department of Epidemiology and Population Health (H.W.C.), Albert Einstein College of Medicine, Bronx, New York 10461

Address all correspondence and requests for reprints to: Jill P. Crandall, M.D., Division of Endocrinology, Belfer 702, 1300 Morris Park Avenue, Bronx, New York 10461. E-mail: crandall{at}aecom.yu.edu.

Context: Post-challenge hyperglycemia (PCH) is common in older adults and is associated with increased cardiovascular disease (CVD) risk and total mortality. However, PCH is rarely recognized in clinical settings, and the glycemic exposure and CVD risk profile of elderly individuals with PCH has not been defined.

Objective: The aim of the study was to characterize metabolic and CVD risk profile of elderly subjects with PCH and to determine the effect of acute postprandial metabolic changes on vascular biomarkers.

Design: We conducted a cross-sectional study with a standard meal challenge protocol.

Participants: Older adults with normal glucose tolerance (n = 30) or PCH (fasting glucose <126 mg/dl and 2-h glucose 170 mg/dl; n = 28) participated in the study.

Main Outcome Measures: We assessed fasting and postprandial levels of glucose, insulin, lipids, high sensitivity C-reactive protein, plasminogen activator inhibitor-1, and adiponectin and endothelial function using reactive hyperemia peripheral arterial tonometry.

Results: Normal glucose tolerance and PCH subjects were matched for age, sex, body mass index, and ethnicity. Fasting glucose (102 ± 3 vs. 93 ± 2 mg/dl; P < 0.001) and glycosylated hemoglobin (5.7 vs. 5.4%; P = 0.01) were modestly higher in the PCH group, which was also more insulin resistant (homeostasis model assessment for insulin resistance, 7.0 ± 1.3 vs. 4.1 ± 0.6; P = 0.03). Fasting high sensitivity C-reactive protein was higher (2.6 ± 0.5 vs. 1.3 ± 0.2 mg/dl; P = 0.05), and adiponectin was lower (11.6 ± 1.6 vs. 14.0 ± 1.3 µg/ml; P = 0.03) in subjects with PCH. Peak and 6-h postprandial area under the curve glucose, insulin, and lipids were higher in PCH subjects, who also had higher fasting and postprandial levels of plasminogen activator inhibitor-1. Reactive hyperemia peripheral arterial tonometry declined postprandially only in PCH.

Conclusions: Older adults with PCH experience significant fasting and postprandial metabolic dysregulation, which is accompanied by a proatherosclerotic and prothrombotic vascular profile.