Blood Glucose and Risk of Cardiovascular Disease in the Asia Pacific Region

Lawes, Carlene M.M.; Parag, Varsha; Bennett, Derrick; Suh, Il; Lam, Tai Hing; Whitlock, Gary; Barzi, Federica; Woodward, Mark

doi:10.2337/diacare.27.12.2836

Cited by 261 publications

(96 citation statements)

References 48 publications

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“…An individual participant data meta‐analysis, including > 250 000 participants without known diabetes and ~13 000 ischaemic heart disease events, found a significantly elevated risk only at fasting blood glucose levels > 6.1 mmol/l 14. Other studies, however, have reported a significant positive association within the ‘normoglycaemic’ range 19; the Asia Pacific Cohort Studies Collaboration found a log‐linear association with ischaemic heart disease extending down to a fasting blood glucose level of 4.9 mmol/l 19. These apparent inconsistencies may reflect differences in populations studied, sample size, glycaemic measures, adjustment for confounders or intra‐individual variation in blood glucose levels and reverse causality.…”

Section: Discussionmentioning

confidence: 97%

Associations of blood glucose and prevalent diabetes with risk of cardiovascular disease in 500 000 adult Chinese: the China Kadoorie Biobank

Bragg

Smith

et al. 2014

Diabet. Med.

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AimsTo examine the relationship of self‐reported diabetes, and of random blood glucose levels among individuals without known diabetes, with the prevalence of cardiovascular disease in Chinese adults.MethodsWe examined cross‐sectional data from the China Kadoorie Biobank of 0.5 million people aged 30–79 years recruited from 10 diverse regions of China in the period 2004–2008. Logistic regression was used to estimate the odds ratios of prevalent cardiovascular disease associated with self‐reported diabetes, and with measured random blood glucose levels among participants with no history of diabetes, adjusting simultaneously for age, sex, area, education, smoking, alcohol, blood pressure and physical activity.ResultsA total of 3.2% of participants had self‐reported diabetes (men 2.9%; women 3.3%) and 2.8% had screen‐detected diabetes (men 2.6%; women 2.8%), i.e. they had no self‐reported history of diabetes but a blood glucose level suggestive of a diagnosis of diabetes. Compared with individuals without a history of diabetes, the odds ratios associated with self‐reported diabetes were 2.18 (95% CI 2.06–2.30) and 1.88 (95% CI 1.75–2.01) for prevalent ischaemic heart disease and stroke/transient ischaemic attack, respectively. Among participants without self‐reported diabetes there was a positive association between random blood glucose and ischaemic heart disease and stroke/transient ischaemic attack prevalence (P for trend <0.0001). Below the diabetic threshold (<11.1 mmol/l) each additional 1 mmol/l of random blood glucose was associated with 4% (95% CI 2–5%) and 5% (95% CI 3–7%) higher odds of prevalent ischaemic heart disease and stroke/transient ischaemic attack, respectively.ConclusionsIn this adult Chinese population, self‐reported diabetes was associated with a doubling of the odds of prevalent cardiovascular disease. Below the threshold for diabetes there was still a modest, positive association between random blood glucose and prevalent cardiovascular disease.

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Section: Discussionmentioning

confidence: 97%

Associations of blood glucose and prevalent diabetes with risk of cardiovascular disease in 500 000 adult Chinese: the China Kadoorie Biobank

Bragg

Smith

et al. 2014

Diabet. Med.

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“…FPG and postprandial hyperglycaemia are correlated with an increased risk of cardiovascular and cerebrovascular diseases, even when they do not reach the diagnostic criteria for diabetes. Diabetic patients often present important risk factors for cardiovascular and cerebrovascular diseases, such as dyslipidemia and hypertension 94, 95.…”

Section: Prevention and Treatment Of Cardiovascular And Cerebrovasculmentioning

confidence: 99%

Standards of care for type 2 diabetes in China

Weng

Jia

et al. 2016

Diabetes Metabolism Res

268

280

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“…Previous cohort studies have found that diabetes nearly doubled the risk of stroke incidence and doubled or even quadrupled the risk of death from stroke, after adjustment for other risk factors [1,2,3,4,5,6]. Many cohort studies have also investigated the association between blood glucose level and stroke and revealed the relationships of fasting blood glucose level and postprandial blood glucose level with stroke [7,8,9,10,11,12,13,14]. …”

Section: Introductionmentioning

confidence: 99%

Glycated Hemoglobin and Risk of Stroke, Ischemic and Hemorrhagic, in Japanese Men and Women

et al. 2008

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Background: The relationship between glycated hemoglobin A_1c (HbA_1c) and stroke has not been fully elucidated. In addition, there have been few reports from Asia, and few trials have been conducted for each stroke subtype. Methods: A prospective cohort study was performed involving 32,726 participants (9,558 men and 23,168 women) aged 40–79 years at baseline with approximately 6 years of follow-up in a general population of Japan. The end points included the incidence of all, ischemic and hemorrhagic strokes. Multivariate-adjusted hazard ratios by 6 HbA_1c categories were calculated using a Cox proportional hazard model. Results: During the follow-up, 393 participants developed a stroke, including 240 ischemic and 139 hemorrhagic stroke cases. The adjusted hazard ratios of all strokes and ischemic stroke showed tendencies to increase with HbA_1c level, and the relationships were independent of other confounders. The adjusted hazard ratios of ischemic stroke incidence showed an apparent and graded increase from a relatively mild HbA_1c level (≧6.0%); the HRs (95% CI) were 1.79 (1.10–2.93) for HbA_1c 6.0–6.4%, 2.20 (1.21–4.00) for HbA_1c 6.5–6.9% and 2.91 (1.91–4.44) for HbA_1c ≧7.0% compared with the category of HbA_1c 5.0–5.4%. For hemorrhagic stroke incidence, no significant increase due to rises in HbA_1c level was observed. Conclusions: The relationship of the risk of stroke, especially ischemic stroke, to HbA_1c in the general population appears to be graded without any apparent threshold. The ischemic stroke risk would increase from a relatively mild HbA_1c level of ≧6.0%.

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Blood Glucose and Risk of Cardiovascular Disease in the Asia Pacific Region

Abstract: Fasting blood glucose is an important determinant of CVD burden, with considerable potential benefit of usual blood glucose lowering down to levels of at least 4.9 mmol/l.

Cited by 261 publications

References 48 publications

Associations of blood glucose and prevalent diabetes with risk of cardiovascular disease in 500 000 adult Chinese: the China Kadoorie Biobank

Associations of blood glucose and prevalent diabetes with risk of cardiovascular disease in 500 000 adult Chinese: the China Kadoorie Biobank

Standards of care for type 2 diabetes in China

Glycated Hemoglobin and Risk of Stroke, Ischemic and Hemorrhagic, in Japanese Men and Women

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