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Long-term Absolute Risk for Cardiovascular Disease Stratified by Fasting Glucose Level.
Pubmed ID: 30617142
Pubmed Central ID: PMC6385698
Journal: Diabetes care
Publication Date: March 1, 2019
MeSH Terms: Humans, Male, Adult, Female, Aged, Cardiovascular Diseases, Risk Factors, United States, Middle Aged, Coronary Disease, Diabetic Angiopathies, Diabetes Mellitus, Blood Glucose, Fasting, Blood Glucose Self-Monitoring
Grants: R21 HL085375, K23 HL133601, R01 HL136942, P20 GM121334
Authors: Lloyd-Jones DM, Carnethon MR, Bertoni AG, Ning H, Wilkins JT, Allen NB, Correa A, Lange LA, Echouffo-Tcheugui JB, Bancks MP
Cite As: Bancks MP, Ning H, Allen NB, Bertoni AG, Carnethon MR, Correa A, Echouffo-Tcheugui JB, Lange LA, Lloyd-Jones DM, Wilkins JT. Long-term Absolute Risk for Cardiovascular Disease Stratified by Fasting Glucose Level. Diabetes Care 2019 Mar;42(3):457-465. Epub 2019 Jan 7.
Studies:
Abstract
OBJECTIVE: To estimate the long-term absolute risk for cardiovascular disease (CVD) according to fasting glucose (FG) levels below the threshold of diabetes. RESEARCH DESIGN AND METHODS: We pooled data from seven observational cohorts of U.S. black and white men and women followed from 1960 to 2015. We categorized FG as follows: <5.0, 5.0-5.5, 5.6-6.2, 6.3-6.9 mmol/L, and diabetes (FG ≥7.0 mmol/L or use of diabetes medications). CVD was defined as fatal/nonfatal coronary heart disease and fatal/nonfatal stroke. We estimated the risk of CVD by FG category at index age 55 years using a modified Kaplan-Meier survival analysis, adjusted for the competing risk of non-CVD death. We also assessed risk for incident CVD according to change in FG before 50 years of age, specifically among the categories <5.6 mmol/L, 5.6-6.9 mmol/L, and diabetes. RESULTS: Our sample included 19,630 individuals (6,197 blacks and 11,015 women) without a prior CVD event. Risk for CVD through 85 years of age ranged from 15.3% (<5.0 mmol/L) to 38.6% (diabetes levels) among women and from 21.5% (5.0-5.5 mmol/L) to 47.7% (diabetes levels) among men. An FG of 6.3-6.9 mmol/L was associated with higher long-term CVD risk compared with the lowest FG among men but not women. Increases in glucose during midlife with conversion to diabetes were associated with higher cardiovascular risk (1.3- to 3.6-fold) than increases in glucose below the diabetes threshold. CONCLUSIONS: Middle-age individuals with diabetes have high long-term absolute risk for CVD. These data strongly support the importance of blood glucose monitoring in midlife for CVD prevention.