Fasting Blood Glucose and the Risk of Stroke and Myocardial Infarction

Sung, Joohon; Song, Yun-Mi; Ebrahim, Shah; Lawlor, Debbie A.

doi:10.1161/circulationaha.108.776989

Cited by 66 publications

(51 citation statements)

References 43 publications

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“…It would also have been very interesting if the risk for cardiovascular outcomes across progressively higher fasting glucose levels (measured as a continuous variable) had been presented in addition to the risk across discrete categories of fasting glucose. Such an analysis would be relevant in light of the spline distribution of the data (Data Supplement Figure I in the article by Sung et al 19 ), which is consistent with a progressive versus a threshold relationship between fasting glucose levels and both myocardial infarction and ischemic stroke.…”

Section: Article P 812mentioning

confidence: 63%

“…Thus, organ systems may vary in their susceptibility to damage related to glucometabolic abnormalities, a conclusion strongly supported by the epidemiological analysis reported in this issue of Circulation. 19 Sung et al 19 report an analysis of 652 901 Korean men 30 to 64 years of age who were followed up over a 9-year period with biannual health examinations within the Korean National Health Insurance system. They calculated average glucose levels for participants followed up during this interval of time and grouped them within clinically relevant categories.…”

Section: Article P 812mentioning

confidence: 99%

“…25 Data from this and other trials underway will clarify the therapeutic implications of epidemiological observations such as those published in this issue. 19 Disclosures Dr Gerstein's institution receives funding from Sanofi-Aventis to conduct the ORIGIN trial of the effect of lowering fasting glucose levels with glargine insulin on cardiovascular outcomes. Dr Gerstein holds the McMaster Population Health Research Institute Chair in Diabetes (sponsored by Aventis).…”

Section: Article P 812mentioning

confidence: 99%

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Dysglycemia and Cardiovascular Risk in the General Population

Gerstein

2009

Circulation

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Diabetes is a metabolic disorder that is diagnosed when the fasting and/or postload glucose level rises above well-established thresholds. These thresholds were chosen because they identified people at particularly high risk for retinopathy based on epidemiological data. These data also have shown that people with diabetes and poorly controlled glucose levels have higher risks of retinopathy than people with diabetes and well-controlled glucose levels. 1,2 Moreover, recent studies have shown that the relationship between chronically elevated glucose levels (as measured by A 1c ) and retinal disease is not confined to people with diabetes and is apparent (although less marked) in people with high glucose levels that are below the diabetes cutoffs such as those with impaired glucose tolerance and/or impaired fasting glucose. [3][4][5] Thus, there is a progressive relationship between glycemia and retinopathy that extends below glucose thresholds for diabetes. Article p 812Clearly, diabetes also is a risk factor for many other serious chronic diseases, including cardiovascular disease. 6 Indeed, a recent meta-analysis of large prospective studies comprising 450 000 people showed that men and women with diabetes are 2 and 3 times more likely, respectively, to die of coronary heart disease than men and women without diabetes. 7 Other studies have shown that the degree of glucose elevation measured by A 1c , fasting glucose, or postload glucose is progressively related to the incidence of cardiovascular outcomes in people with established diabetes and in people without diabetes after adjustment for age and varying numbers of other risk factors. 8 -15 Moreover, several studies that recruited people from both ambulatory and hospitalized settings suggest that there may be a stronger relationship between glycemia and incident cardiovascular outcomes in people without diabetes than in people with diabetes. 8,9,[15][16][17] Such a discrepancy may occur because in people with established diabetes, markers of glycemia are a measure of both adequacy of therapy and exposure to hyperglycemia, whereas they reflect only exposure to hyperglycemia in people without diabetes (in whom glucose and A 1c levels are not targets for therapy).Retinopathy and cardiovascular disease are clearly not the only outcomes related to progressively higher glucose levels. This is perhaps best illustrated by epidemiological analyses of prospective data from the United Kingdom Prospective Diabetes Study (UKPDS), which recruited people with a fasting plasma glucose level Ͼ6 mmol/L 18 and which therefore included individuals with newly diagnosed diabetes as well as some individuals who would be classified as having impaired fasting glucose and not diabetes based on today's diagnostic criteria for diabetes (ie, fasting glucose level Ն7 mmol/L). As noted in the Figure, these analyses showed that progressively higher A 1c levels predicted progressively higher hazards of severe retinal or renal disease, cataracts, myocardial infarction, heart failure, amputa...

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Section: Article P 812mentioning

confidence: 63%

Section: Article P 812mentioning

confidence: 99%

Section: Article P 812mentioning

confidence: 99%

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Dysglycemia and Cardiovascular Risk in the General Population

Gerstein

2009

Circulation

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“…[4][5][6][7][8] Both entities are strongly correlated, 9 and the combined occurrence substantially increases cardiovascular risk in affected individuals. 10,11 Although various factors, including hyperinsulinemia, volume expansion, and increased arterial stiffness, have been linked to elevated BP among diabetics, 12 mechanisms that predispose to the development of both dysglycemia and hypertension remain controversial and incompletely understood. 13 The incretin hormone glucagon-like peptide-1 (GLP-1) mediates its main effects by GLP-1 receptors (GLP-1R), which are found ubiquitously in the cardiovascular and renal system, including smooth muscle and endothelial cells.…”

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confidence: 99%

Glucagon-Like Peptide-1 and Blood Pressure in Young and Healthy Adults from the General Population

et al. 2015

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All study participants included in the current analysis are participants of the prospective genetic and phenotypic determinants of BP and other cardiovascular risk factors (GAPP) study. Detailed information Abstract-Hypertension and diabetes mellitus are highly correlated, but the underlying mechanisms are only partly understood.Therefore, the aim of our study was to investigate the relationships between plasma levels of glucagon-like peptide-1, a key factor in the regulation of glucose homeostasis, and various blood pressure indices. Healthy adults aged 25 to 41 years were enrolled in a population-based study. Established cardiovascular disease, diabetes mellitus, or a body mass index >35 kg/m 2 were exclusion criteria. Fasting plasma glucagon-like peptide-1 levels as determined with a novel high-sensitive assay and ambulatory blood pressure data were available in 1479 participants not using antihypertensive treatment. Median age of our population was 38 years. Mean systolic and diastolic blood pressure across increasing glucagon-like peptide-1 quartiles were 120.6, 122.8, 123.2, and 124.9 mm Hg and 77.1, 78.7, 78.9, and 79.9 mm Hg, respectively. We found a linear relationship of glucagon-like peptide-1 with 24-hour ambulatory blood pressure after multivariable adjustment (β per 1 log-unit increase 2.01; 95% confidence interval, 1.02-3.00; P<0.0001 for systolic and 1.22; 0.47-1.97; P=0.002 for diastolic blood pressure). In separate analyses, glucagon-like peptide-1 was significantly related to both awake (β per 1 logunit increase 2.05; 1.02-3.09; P=0.0001 for systolic and 1.15; 0.35-1.96; P=0.005 for diastolic blood pressure) and asleep blood pressure (β per 1 log-unit increase 1.34; 0.26-2.42; P=0.01 for systolic and 1.05; 0.26-1.84; P=0.009 for diastolic blood pressure). In conclusion, plasma levels of glucagon-like peptide-1 are significantly associated with both systolic and diastolic blood pressure levels. (Hypertension. 2015;65:306-312.

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“…Et al., 2004;Sung J. et al 2009). The cumulative effect of many metabolic risk factors (clinical and biochemical) in one individual which influenced cardiovascular risk are widely discussed (Selvin E. et al, 2005;Gerstein HC.…”

Section: Disscusionmentioning

confidence: 99%