Fasting Glucose Level and the Risk of Incident Atherosclerotic Cardiovascular Diseases

Abstract

OBJECTIVEAlthough 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 METHODSA 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.RESULTSThe 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.CONCLUSIONSBoth 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.

Trajectories of Long‐Term Normal Fasting Plasma Glucose and Risk of Coronary Heart Disease: A Prospective Cohort Study

“…On the other hand, hypoglycemia or rapid changes in plasma glucose may lead to elevations of counterregulatory hormones, such as epinephrine and norepinephrine, and these increases induce vasoconstriction and platelet aggregation 3, 15. Furthermore, there is evidence that rapidly increasing glucose concentrations, rather than gradual increases, occur late in diabetes mellitus,16, 17 and individuals with stable FPG concentrations are less likely to develop diabetes mellitus.…”

“…Thus, the association between FPG and CHD had been extensively studied. Park et al3 reported a J‐shaped association between fasting glucose levels and cardiovascular disease risk across the full range of FPG values. It had also been demonstrated that the angiographic CHD prevalence increases with increasing FPG levels 4.…”

Elevated Risk of an Intermediate or High SYNTAX Score in Subjects with Impaired Fasting Glucose

“…Although diabetes increases the risk of CVD and mortality, the dose-response relationship between a fasting glucose level below that diagnostic for diabetes with cardiovascular events has not been well characterized (12). Impaired fasting glucose should be considered a predictor of the risk of CAD (12) and Shaye et al (13) found that an elevated CVD risk is strongly and independently associated with a glucose level within the normoglycemic range.…”

Ageing and fasting glucose values – the role of cardiovascular events

“…Increased fasting glucose levels are related to insulin resistance and thus to the metabolic syndrome with a cascade of cardiovascular risk factors (CRF) [1][2][3][4]. The impact of abnormal glucose metabolism, hypertension and dyslipidemia on cardiovascular morbidity and mortality was demonstrated by numerous epidemiological and clinical studies [5][6][7][8].…”