Cardiovascular Disease Mortality in Europeans in Relation to Fasting and 2-h Plasma Glucose Levels Within a Normoglycemic Range

OBJECTIVE To study mortality in relation to fasting plasma glucose (FPG) and 2-h plasma glucose levels within the normoglycemic range. RESEARCH DESIGN AND METHODS Data from 19 European cohorts comprising 12,566 men and 10,874 women who had FPG <6.1 mmol/l and 2-h plasma glucose <7.8 mmol/l at baseline examination were analyzed. Multivariate-adjusted hazard ratios (HRs) and 95% CIs for deaths from cardiovascular disease (CVD), non-CVD, and all causes were estimated for individuals whose 2-h plasma glucose > FPG (group II) compared with those whose 2-h plasma glucose ≤ FPG (group I). RESULTS A total of 827 (246) CVD and 611 (351) non-CVD and 1,438 (597) all-cause deaths occurred in men (women). Group II was older and had higher BMI, blood pressure, and fasting insulin than group I. The multivariate-adjusted HRs (95% CIs) for CVD, non-CVD, and all-cause mortality were 1.22 (1.05–1.41), 1.09 (0.92–1.29), and 1.16 (1.04–1.30) in men and 1.40 (1.03–1.89), 0.99 (0.79–1.25), and 1.13 (0.94–1.35) in women, respectively, for group II as compared with group I. HRs were 1.25 (1.05–1.50), 1.09 (0.89–1.34), and 1.18 (1.03–1.35) in men and 1.60 (1.03–2.48), 1.05 (0.78–1.42), and 1.18 (0.93–1.51) in women, respectively, after additional adjustment for fasting insulin in a subgroup of individuals. CONCLUSIONS In individuals with both FPG and 2-h plasma glucose within the normoglycemic range, high 2-h plasma glucose was associated with insulin resistance and increased CVD mortality.

[1]  G. Sesti,et al.  Differences in cardiovascular risk profile based on relationship between post‐load plasma glucose and fasting plasma levels , 2009, Diabetes/metabolism research and reviews.

[2]  J. Tuomilehto,et al.  Hyperglycemia and Stroke Mortality , 2009, Diabetes Care.

[3]  J. Shaw,et al.  Continuous relationships between non-diabetic hyperglycaemia and both cardiovascular disease and all-cause mortality: the Australian Diabetes, Obesity, and Lifestyle (AusDiab) study , 2009, Diabetologia.

[4]  Q. Qiao,et al.  Comparison of different definitions of the metabolic syndrome in relation to cardiovascular mortality in European men and women , 2006, Diabetologia.

[5]  A. Shahab.  Why does diabetes mellitus increase the risk of cardiovascular disease? , 2006, Acta medica Indonesiana.

[6]  D. McGee,et al.  Body mass index and mortality: a meta-analysis based on person-level data from twenty-six observational studies. , 2005, Annals of epidemiology.

[7]  Masafumi Matsuda,et al.  beta-Cell function in subjects spanning the range from normal glucose tolerance to overt diabetes: a new analysis. , 2005, The Journal of clinical endocrinology and metabolism.

[8]  T. Md.  Hyperglycaemia and mortality from all causes and from cardiovascular disease in five populations of Asian origin , 2004, Diabetologia.

[9]  J. Tuomilehto,et al.  Is the current definition for diabetes relevant to mortality risk from all causes and cardiovascular and noncardiovascular diseases? , 2003, Diabetes care.

[10]  G. Gallus,et al.  Age- and sex-specific prevalences of diabetes and impaired glucose regulation in 13 European cohorts. , 2003, Diabetes care.

[11]  L. Guize,et al.  Impaired Fasting Glucose, Blood Pressure and Cardiovascular Disease Mortality , 2002, Hypertension.

[12]  J. Tuomilehto,et al.  Two-hour glucose is a better risk predictor for incident coronary heart disease and cardiovascular mortality than fasting glucose. , 2002, European heart journal.

[13]  B. Howard,et al.  Diabetes and cardiovascular disease , 2000, Annual review of medicine.

[14]  E. Feskens,et al.  Glucose tolerance and cardiovascular mortality: comparison of fasting and 2-hour diagnostic criteria. , 2001, Archives of internal medicine.

[15]  J. Kampert,et al.  Low fasting plasma glucose level as a predictor of cardiovascular disease and all-cause mortality. , 2000, Circulation.

[16]  E. Feskens,et al.  Glucose tolerance and mortality: comparison of WHO and American Diabetic Association diagnostic criteria , 1999, The Lancet.

[17]  J. Sowers,et al.  Diabetes and cardiovascular disease. , 1999, Diabetes care.

[18]  S. Yusuf,et al.  The relationship between glucose and incident cardiovascular events. A metaregression analysis of published data from 20 studies of 95,783 individuals followed for 12.4 years. , 1999, Diabetes care.

[19]  Glucose tolerance and mortality: comparison of WHO and American Diabetes Association diagnostic criteria. The DECODE study group. European Diabetes Epidemiology Group. Diabetes Epidemiology: Collaborative analysis Of Diagnostic criteria in Europe. , 1999, Lancet.

[20]  Bruce Neal,et al.  1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension. Guidelines Subcommittee. , 1999, Journal of hypertension.

[21]  H. Lithell,et al.  Will new diagnostic criteria for diabetes mellitus change phenotype of patients with diabetes? Reanalysis of European epidemiological data , 1998 .

[22]  Steno Diabetes.  Will new diagnostic criteria for diabetes mellitus change phenotype of patients with diabetes? Reanalysis of European epidemiological data. DECODE Study Group on behalf of the European Diabetes Epidemiology Study Group. , 1998, BMJ.

[23]  J. Neaton,et al.  Diabetes, Other Risk Factors, and 12-Yr Cardiovascular Mortality for Men Screened in the Multiple Risk Factor Intervention Trial , 1993, Diabetes Care.

[24]  R. DeFronzo,et al.  Fasting hyperglycemia in non-insulin-dependent diabetes mellitus: contributions of excessive hepatic glucose production and impaired tissue glucose uptake. , 1989, Metabolism: clinical and experimental.

[25]  B V Howard,et al.  Relationships between insulin secretion, insulin action, and fasting plasma glucose concentration in nondiabetic and noninsulin-dependent diabetic subjects. , 1984, The Journal of clinical investigation.

[26]  W. Kannel,et al.  Diabetes and cardiovascular disease. The Framingham study. , 1979, JAMA.