Fasting Glucose Level and the Risk of Incident Atherosclerotic Cardiovascular Diseases

Park, Chanshin MD
Guallar, Eliseo MD
Linton, John A. MD
Lee, Duk-Chul MD
Jang, Yangsoo MD
Son, Dong Koog PHD
Han, Eun-Jeong MS
Baek, Soo Jin MS
Yun, Young Duk MD
Jee, Sun Ha PHD
Samet, Jonathan M. MD

¹International Health Care Center, Severance Hospital, Seoul, Korea
²Departments of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology, and Cardiovascular Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
³Department of Cardiovascular Epidemiology and Population Genetics, National Center for Cardiovascular Research (CNIC), Madrid, Spain
⁴Department of Family Medicine, Yonsei University College of Medicine, Seoul, Korea
⁵Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
⁶National Health Insurance Service, Seoul, Korea
⁷Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea
⁸Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea
⁹Department of Preventive Medicine, Keck School of Medicine, and Institute for Global Health, University of Southern California, Los Angeles, California

Corresponding author: Sun Ha Jee, [email protected]

Received August 7, 2012

Accepted December 18, 2012

Diabetes Care 36(7):p 1988-1993, July 2013. | DOI: 10.2337/dc12-1577

OBJECTIVE

Although diabetes increases the risk of cardiovascular disease (CVD) and mortality, the dose-response relationship between fasting glucose levels below those diagnostic of diabetes with cardiovascular events has not been well characterized.

RESEARCH DESIGN AND METHODS

A prospective cohort study of more than one million Koreans was conducted with a mean follow-up of 16 years. A total of 1,197,384 Korean adults with no specific medical conditions diagnosed were classified by baseline fasting serum glucose level. Associations of fasting glucose level with CVD incidence and mortality, stroke incidence and mortality, and all-cause mortality were analyzed using multivariate proportional hazards regression.

RESULTS

The relationships between fasting glucose levels and CVD risks generally followed J-shape curves, with lowest risk in the glucose range of 85–99 mg/dL. As fasting glucose levels increased to >100 mg/dL, risks for CVD, ischemic heart disease, myocardial infarction, and thrombotic stroke progressively increased, but risk for hemorrhagic stroke did not. Fasting glucose levels <70 mg/dL were associated with increased risk of all stroke (hazard ratio 1.06, 95% CI 1.01–1.11) in men and (hazard ratio 1.11, 1.05–1.17) in women.

CONCLUSIONS

Both low glucose level and impaired fasting glucose should be considered as predictors of risk for stroke and coronary heart disease. The fasting glucose level associated with the lowest cardiovascular risk may be in a narrow range.