Scholarly Article
Glycemic Burden and Carotid Atherosclerotic Phenotype Across Cerebrovascular Presentations: Independent Associations of HbA1c, Fasting and Postprandial Glucose With cIMT and Plaque
Saha, Ashis Kumar, Hazra, Kaushik
2026-10-16 · International Journal of Clinical and Biomedical Research · Sumathi Publications
Abstract
Background: Dysglycemia contributes to vascular injury, but the relative associations of HbA1c, fasting blood glucose (FBS), and postprandial blood glucose (PPBS) with carotid atherosclerosis across different cerebrovascular presentations remain uncertain.Aims and Objectives: To compare the independent associations of HbA1c, FBS, and PPBS with carotid intima-media thickness (cIMT) and carotid plaque and assess whether these relationships differ among ischemic infarction (INF), transient ischemic attack (TIA), and intracerebral hemorrhage (ICH). Materials and Methods: This cross-sectional observational study analyzed 447 patients. The principal disease-group cohort comprised 235 INF, 92 TIA, and 57 ICH patients. Mean and maximum cIMT, overall plaque, bilateral plaque, and internal carotid artery (ICA) plaque were evaluated. Correlation, multivariable linear and logistic regression, restricted cubic spline, interaction, and AUROC analyses were performed after adjustment for major vascular risk factors. Results: HbA1c, FBS, and PPBS were not independently associated with mean or maximum cIMT or carotid plaque. Mean cIMT was similar across INF, TIA, and ICH (P=0.987). Overall plaque prevalence differed significantly: 61.0% in INF, 39.7% in TIA, and 53.1% in ICH (P=0.006). ICA plaque also differed significantly (P=0.026). INF demonstrated higher adjusted odds of plaque than TIA (OR 2.47, 95% CI 1.38-4.40; P=0.002). Addition of glycemic markers minimally improved plaque discrimination (AUROC 0.664 to 0.668). Formal interaction analyses showed no convincing effect modification. Conclusion: In established cerebrovascular disease, carotid plaque phenotype, particularly ICA plaque, provides greater clinical discrimination than cIMT or single contemporaneous glycemic measurements. Plaque characterization may therefore enhance vascular phenotyping across cerebrovascular presentations.
Keywords
HbA1c, Fasting blood glucose, Postprandial blood glucose, Carotid intima-media thickness, Carotid plaque, Cerebrovascular disease
Citation Details
International Journal of Clinical and Biomedical Research, Vol. 11, No. 4, pp. 8-20