GHb Is a Better Predictor of Cardiovascular Disease Than Fasting or Postchallenge Plasma Glucose in Women Without Diabetes: The Rancho Bernardo Study

Park, Sue; Barrett‐Connor, Elizabeth; Wingard, Deborah L.; Sakata, Jun; Edelstein, Sharon L.

doi:10.2337/diacare.19.5.450

Cited by 167 publications

(174 citation statements)

References 19 publications

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“…HbA 1c better characterizes the status of glycemia and might thereby reduce misclassi®cation of subjects. Results from a prospective study on the association of HbA 1c -levels to cardiovascular disease (CVD) and ischemic heart disease (IHD) mortality support this idea [30]. While HbA 1c predicted both CVD and IHD mortalities in women, neither FPG nor PLPG were independently predictive in men or women.…”

Section: Discussionsupporting

confidence: 49%

Arterial hypertension and glycemia in non-diabetic subjects: is there an association independent of obesity?

Kroke¹,

Liese²,

Keil³

et al. 1999

Diabetes Metab. Res. Rev.

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Section: Discussionsupporting

confidence: 49%

Arterial hypertension and glycemia in non-diabetic subjects: is there an association independent of obesity?

Kroke¹,

Liese²,

Keil³

et al. 1999

Diabetes Metab. Res. Rev.

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“…For ease of presentation, we grouped them together in one category in our figure. For Rancho Bernardo, we have included the report of Park et al (23) for the 2hPG since these were not reported in the earlier study by Barrett-Connor et al (19). The cut points for the FPG were more informative for this report in the earlier study (19) than in the later study (23).…”

Section: Construction Of Figs 1 and 2 (Summaries Of Published Studies)mentioning

confidence: 81%

The Relation of Fasting and 2-h Postchallenge Plasma Glucose Concentrations to Mortality

et al. 2005

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OBJECTIVE -Under the auspices of the National Institutes of Health, American Diabetes Association, and World Health Organization, expert committees lowered the fasting plasma glucose (FPG) concentration diagnostic for diabetes from 7.8 to 7.0 mmol/l and defined 6.1-6.9 mmol/l as impaired fasting glucose (IFG) and Ͻ6.1 mmol/l as normal fasting glucose. In 2003, IFG was lowered to 5.6 -6.9 mmol/l and normal fasting glucose to Ͻ5.6 mmol/l. Reports of the relationship between glucose concentration and all-cause mortality have been inconsistent. It is not known if the 2-h plasma glucose (2hPG) concentration from an oral glucose tolerance test (OGTT) adds to the predictive power of FPG.RESEARCH DESIGN AND METHODS -We followed 1,236 men for an average of 13.4 years to determine the relationship between both FPG and 2hPG and all-cause mortality.RESULTS -Risk for mortality did not increase until the FPG exceeded 6.1 mmol/l. Risk increased by ϳ40% in the 6.1-6.9 mmol/l range and doubled when FPG ranged from 7.0 to 7.7 mmol/l. A combination of the 2hPG and FPG allowed better estimation of risk than the FPG alone. Within any category of FPG, risk generally increased as the 2hPG increased, and within any category of 2hPG, risk generally increased as the FPG increased.CONCLUSIONS -These data support the decision to lower the FPG diagnostic for diabetes from 7.8 to 7.0 mmol/l, show that both IFG and impaired glucose tolerance have risks between the normal and diabetic ranges, and show that the OGTT adds predictive power to that of FPG alone and should not be abandoned. The lowering of IFG to 5.6 mmol/l from 6.1 mmol/l, at least for mortality, is, however, not supported by our results. (5), and 1999 (6). Over this 25-year period, standards for interpreting the oral glucose tolerance test (OGTT) were identical and unchanged in the U.S. and WHO reports; an impaired zone was defined as 140 -199 mg/dl (7.8 -11.0 mmol/l) and the diabetic cut point was defined as 200 mg/dl (11.1 mmol/l). The standards for interpreting the FPG changed over the years. In the early reports, no impaired zone was defined (1,4,5). Both the U.S. and WHO committees recommended that the cut point for diabetes be 140 mg/dl (7.8 mmol/l). In subsequent reports, the U.S. (2) and WHO (6) recommended that an impaired fasting glucose (IFG) zone of 110 -125 mg/dl (6.1-6.9 mmol/l) be created and also that the diabetic cut point be lowered to 126 mg/dl (7.0 mmol/l). Most recently (3), the U.S. committee changed the IFG zone to 100 -125 mg/dl (5.6 -6.9 mmol/l). Inevitably, data from population studies have become difficult to compare and to interpret because the definitions of impaired and diabetic test results have changed. Diabetes CareThe purpose of the present study is to examine the risks of mortality from these variously defined categories of glucose metabolism, to evaluate whether the OGTT adds power to the FPG value as a predictor of risk, and to examine the literature critically with respect to these questions.RESEARCH DESIGN AND METHODS -The 1,236 men include...

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“…21 On the other hand, prospective studies have shown that increasing HbA 1c levels increase the risk of cardiovascular diseases among nondiabetic people. [5][6][7] It is therefore not unlikely that the degree of glycemia also contributes to atherogenesis and that this process takes place already at modestly elevated levels of HbA 1c . Furthermore, several plausible mechanisms such as oxidative stress and protein glycation of the vessel walls may link glycemic status to atherosclerosis.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 Previous studies have shown that HbA 1c concentration is related to mortality and cardiovascular disease in nondiabetic persons. [5][6][7][8] Few studies have examined the possible relationship between HbA 1c and atherosclerosis in subjects not diagnosed with diabetes. 9 -14 In these studies, high levels of HbA 1c were associated with raised atherosclerotic lesions and more extensive fatty streaks in the coronary artery, 12 and increasing levels were positively associated with carotid IMT 10,13,14 and carotid plaque prevalence.…”

mentioning

confidence: 99%

Glycated Hemoglobin Level Is Strongly Related to the Prevalence of Carotid Artery Plaques With High Echogenicity in Nondiabetic Individuals

et al. 2004

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Background-High levels of HbA 1c have been associated with increased mortality and an increased risk of atherosclerosis assessed as carotid intima-media thickness or plaque prevalence. In the present population-based study, we examined the association between HbA 1c and plaque prevalence with emphasis on plaque echogenicity in subjects not diagnosed with diabetes. Methods and Results-HbA 1c measurements and ultrasonography of the carotid artery were performed in 5960 subjects (3026 women, 2934 men) 25 to 84 years of age. Plaque morphology was categorized into 4 groups from low echogenicity (soft plaque) to strong echogenicity (hard plaque

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GHb Is a Better Predictor of Cardiovascular Disease Than Fasting or Postchallenge Plasma Glucose in Women Without Diabetes: The Rancho Bernardo Study

Abstract: We concluded that GHb is a better predictor of CVD and IHD mortality than FPG or PCPG in women without diabetes; no single measure of glycemia was predictive in men. The reason for the sex difference is unexplained.

Cited by 167 publications

References 19 publications

Arterial hypertension and glycemia in non-diabetic subjects: is there an association independent of obesity?

Arterial hypertension and glycemia in non-diabetic subjects: is there an association independent of obesity?

The Relation of Fasting and 2-h Postchallenge Plasma Glucose Concentrations to Mortality

Glycated Hemoglobin Level Is Strongly Related to the Prevalence of Carotid Artery Plaques With High Echogenicity in Nondiabetic Individuals

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