Fasting Glucose Level and the Risk of Incident Atherosclerotic Cardiovascular Diseases

• Published in: Diabetes care Vol. 36; no. 7; pp. 1988 - 1993
• Main Authors: PARK, Chanshin, GUALLAR, Eliseo, SAMET, Jonathan M, LINTON, John A, LEE, Duk-Chul, YANGSOO JANG, DONG KOOG SON, HAN, Eun-Jeong, SOO JIN BAEK, YOUNG DUK YUN, SUN HA JEE
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01-07-2013
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Blood Glucose - metabolism; Blood sugar; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - blood; Cardiovascular Diseases - epidemiology; Cholesterol; Coronary Disease - blood; Coronary Disease - epidemiology; Diabetes; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Fasting - blood; Female; Glucose; Glucose metabolism; Humans; Male; Medical sciences; Metabolic diseases; Middle Aged; Miscellaneous; Mortality; Original Research; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk Factors; Stroke (Disease); Stroke - blood; Stroke - epidemiology; Womens health; Maryland; South Korea; Vascular disease; Human; Nutrition; Atherosclerosis; Risk factor; Metabolic diseases; Cardiovascular disease; Risk; Fast; Endocrinology; Glycemia
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/dc12-1577

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.
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.
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.
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.