Association Between Hemoglobin Glycation Index and Coronary Artery Inflammation in Type 2 Diabetes Mellitus Based on CCTA

Summary

This study analyzed data from patients with type 2 diabetes mellitus to examine the association between hemoglobin glycation index (HGI) and coronary artery inflammation. Higher HGI levels were linked to increased perivascular inflammation and CT high-risk plaques, suggesting HGI as a potential marker for cardiovascular risk assessment.

Abstract

Hemoglobin glycation index (HGI) is used to quantify the biological variation of hemoglobin A1c (HbA1c). The present study explored the relationship between HGI and coronary artery inflammation in patients with type 2 diabetes mellitus (T2DM). A total of 360 diseased coronary arteries from 185 T2DM patients. Patients and their diseased vessels were categorized into three distinct groups according to the tertiles of HGI: H1 (low group), H2 (medium group), and H3 (high group). Clinical baseline data, perivascular fat attenuation index (FAI) within the proximal 40 mm of the three coronary arteries, quantitative plaque parameters, and the proportion of computed tomography (CT) high-risk plaque features were compared. Moreover, a multivariate logistic regression analysis was used to analyze the risk factors for CT high-risk plaques. The results showed that the perivascular FAI of the left anterior descending artery (LAD) and left circumflex artery (LCX), fibrous, and lipid component volumes, as well as their respective volume ratios, increased with an increase in HGI (P<0.05). The prevalence of CT high-risk plaques also increased with an increase in HGI (P<0.001). HGI (odds ratio (OR) = 1.764, 95% confidence interval (CI) = 1.363–2.284, P<0.001) and LAD-FAI (OR = 1.086, 95% CI = 1.032–1.143, P<0.05) were independent risk factors for CT high-risk plaques. In conclusion, HGI may serve as a potential complementary biomarker for coronary inflammation and plaque vulnerability in patients with T2DM, and warrants further validation in larger prospective studies.

Introduction

Atherosclerotic cardiovascular disease (ASCVD) remains the primary global cause of mortality and disability, with older adults (≥60 years) representing a vulnerable population at elevated cardiovascular risk¹. Type 2 diabetes mellitus (T2DM), which ranks as one of the most prevalent chronic conditions worldwide, is linked to various complications. Among individuals with T2DM, coronary artery disease (CAD) represents the leading factor contributing to unfavorable outcomes². CAD is primarily caused by a chronic inflammatory process due to coronary atherosclerosis, lipid metabolism, and vascular dysfunction

Protocol

This study was approved by the Institutional Review Board of the Affiliated Hospital of Nantong University (approval No. 2025-K179-01), and the requirement for informed consent was waived. The software and the equipment used are listed in the Table of Materials.

1. Study subjects and grouping

Between January 2016 and May 2023, data were collected for 752 patients with T2DM who underwent CCTA at the Affiliated Hospital of Nantong University. T2DM was diagnosed according to the Guidelines for the Prevention and Treatment of Type 2 Diabetes in China (2020 Edition). The exclusion crite....

Results

Association between HbA1c and FPG

A linear relationship was established between patients’ HbA1c and FPG measurements, deriving the regression equation: predicted HbA1c = 0.28 × FPG + 5.75, with r = 0.508 and P < 0.001 (Figure 3).

Comparison of clinical baseline data and FAI among different groups

HGI values of groups H1, H2, and H3 were -1.29 (-1.71, -1.0.......

Discussion

The present study found that the volume and proportion of calcified and non-calcified plaques increased with an increase in HGI levels. Concurrently, the occurrence and proportion of CT high-risk features (low-attenuation plaques) in coronary artery atherosclerotic plaques also increased with an increase in HGI levels. Measurements of FAI values in the three main coronary arteries showed that LAD-FAI and LCX-FAI values also increased with an increase in HGI levels. After adjusting for other covariates, HGI and LAD-FAI we.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Commercial Workstation	Shukun Technology	AI-assisted diagnostic system for coronary CT imaging	Used for quantitative analysis of coronary atherosclerotic plaques.
Computed Tomography System	GE Healthcare	Revolution CT (256-slice)	Used for coronary computed tomography angiography (CCTA) examinations. Scanning parameters: detector collimation of 160 x 0.5 mm, gantry rotation speed of 0.28 second/rotation, slice thickness of 0.625 mm.
Non-ionic Contrast Agent	Bayer Health-care	Ultravist 370	Intravenous contrast agent. Dosage was 0.8 mL per kg of body weight, injection rate of 5 mL/second, followed by a 20 mL saline flush at the same rate.
Statistical Software	IBM	SPSS 26.0	Used for all statistical analyses, including ANOVA, chi-square tests, and logistic regression analysis.
Vascular Analysis Software	Deepwise Corporation	DW-CACTAS	Used to automatically delineate pericoronary adipose tissue and calculate the fat attenuation index (FAI). Operated by a radiologist blinded to patient information.