Impaired glucose tolerance and the likelihood of nonfatal stroke and myocardial infarction: the Third National Health and Nutrition Examination Survey.

BACKGROUND AND PURPOSE Although diabetes mellitus (DM) is known to increase the risk of cardiovascular disease (CVD), the effect of impaired glucose tolerance (IGT) on the risk remains unclear. We determined whether IGT was associated with an increased likelihood for stroke and myocardial infarction in a nationally representative sample of US adults. METHODS We evaluated the association between IGT (defined as a fasting glucose level of < 140 mg/dL and a plasma glucose level of between 140 and 200 mg/dL 2 hours after administration of 75 grams of an oral glucose load) and DM (defined as the current use of insulin or an oral hypoglycemic medication, a fasting plasma glucose level of > 140 mg/dL, or a plasma glucose level of > 200 mg/dL 2 hours after administration of an oral glucose load) with a self-reported physician diagnosis of stroke and myocardial infarction in 6547 adults aged 40 to 74 years participating in the Third National Health and Nutrition Examination Survey. Multivariate logistic regression analyses were used to investigate these relationships. RESULTS IGT and DM were observed in 1494 and 1532 adults, respectively. After adjustment for differences in age, gender, race/ethnicity, education, hypertension, cholesterol, body mass index, and cigarette smoking, IGT was not associated with stroke (odds ratio [OR], 0.9; 95% confidence interval [CI], 0.5 to 1.6) or myocardial infarction (OR, 1.1; 95% CI, 0.7 to 1.6). DM was associated with both stroke (OR, 1.6; 95% CI, 1.0 to 2.6) and myocardial infarction (OR, 1.9; 95% CI, 1.3 to 2.8). CONCLUSIONS In contrast to DM, IGT was not associated with an increased likelihood of prevalent nonfatal stroke or myocardial infarction.

[1]  L. Wilhelmsen,et al.  Prevalence of angina pectoris and myocardial infarction in a general population sample of Swedish men. , 2009, Acta medica Scandinavica.

[2]  B. Henderson,et al.  Prospective evaluation of dietary and other predictors of fatal stroke in Shanghai, China. , 1997, Circulation.

[3]  K. Alberti.  The Clinical Implications of Impaired Glucose Tolerance , 1996, Diabetic medicine : a journal of the British Diabetic Association.

[4]  M. Knuiman,et al.  Risk Factors for Stroke Mortality in Men and Women: The Busselton Study , 1996, Journal of cardiovascular risk.

[5]  R. Thomson,et al.  Validation of a population screening questionnaire to assess prevalence of stroke. , 1995, Stroke.

[6]  M. Schroll,et al.  Stroke incidence, case fatality, and mortality in the WHO MONICA project. World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease. , 1995, Stroke.

[7]  M. Laakso,et al.  NIDDM and Its Metabolic Control Predict Coronary Heart Disease in Elderly Subjects , 1994, Diabetes.

[8]  J. Mecklin,et al.  The International Collaborative Group on HNPCC. , 1994, Anticancer research.

[9]  M. Rewers,et al.  Prevalence of coronary heart disease in subjects with normal and impaired glucose tolerance and non-insulin-dependent diabetes mellitus in a biethnic Colorado population. The San Luis Valley Diabetes Study. , 1992, American journal of epidemiology.

[10]  S. Haffner,et al.  Cardiovascular risk factors in confirmed prediabetic individuals. Does the clock for coronary heart disease start ticking before the onset of clinical diabetes? , 1990, JAMA.

[11]  E. Barrett-Connor,et al.  Cardiovascular disease risk factors prior to the diagnosis of impaired glucose tolerance and non-insulin-dependent diabetes mellitus in a community of older adults. , 1990, American journal of epidemiology.

[12]  I. Ringqvist,et al.  Validity of a postal questionnaire with regard to the prevalence of myocardial infarction in a general population sample. , 1989, European heart journal.

[13]  L. Wilhelmsen,et al.  A Cross‐sectional Analysis of Glucose Tolerance and Cardiovascular Disease in 67–year‐old Men , 1989, Diabetic Medicine.

[14]  W. Garraway,et al.  THE DICHOTOMY OF MYOCARDIAL AND CEREBRAL INFARCTION , 1983, The Lancet.

[15]  R J Jarrett,et al.  Mortality from coronary heart disease and stroke in relation to degree of glycaemia: the Whitehall study. , 1983, British medical journal.

[16]  Classification and Diagnosis of Diabetes Mellitus and Other Categories of Glucose Intolerance , 1979, Diabetes.

[17]  M. Harris.  Impaired glucose tolerance--prevalence and conversion to NIDDM. , 1996, Diabetic medicine : a journal of the British Diabetic Association.

[18]  G. Nijpels,et al.  New data on the rate of progression of impaired glucose tolerance to NIDDM and predicting factors. , 1996, Diabetic medicine : a journal of the British Diabetic Association.

[19]  R. Jarrett.  The cardiovascular risk associated with impaired glucose tolerance. , 1996, Diabetic medicine : a journal of the British Diabetic Association.

[20]  H. Blackburn,et al.  Improved survival of stroke patients during the 1980s. The Minnesota Stroke Survey. , 1995, Stroke.

[21]  Plan and operation of the Third National Health and Nutrition Examination Survey, 1988-94. Series 1: programs and collection procedures. , 1994, Vital and health statistics. Ser. 1, Programs and collection procedures.

[22]  J. Stamler,et al.  Asymptomatic hyperglycemia and coronary heart disease. A series of papers by the International Collaborative Group, based on studies in fifteen populations. , 1979, Journal of chronic diseases.