Low Fasting Plasma Glucose Level as a Predictor of Cardiovascular Disease and All-Cause Mortality

Mao, Wei; Gibbons, Larry W.; Mitchell, Tedd L.; Kampert, James B.; Stern, Michael P.; Blair, Steven N.

doi:10.1161/01.cir.101.17.2047

Cited by 125 publications

(151 citation statements)

References 24 publications

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“…Prospective epidemiological studies have also found glucose levels to predict the risk of cardiovascular disease mortality. A Jshaped relationship between fasting glucose levels and cardiovascular mortality has been reported, hypo-and hyperglycaemic values being associated with significant increases in cardiovascular risk [43]. A similar J-shaped relationship appears to exist between glucose levels and fibrin clot structure parameters.…”

Section: Discussionmentioning

confidence: 76%

The influence of type 2 diabetes on fibrin structure and function

2005

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Aims/hypothesis: The precise mechanisms underlying the increased risk of cardiovascular disease (CVD) in type 2 diabetes are unclear. Fibrin clot structure has been related to CVD risk in the general population. We therefore assessed this in type 2 diabetic patients as a potential mechanism whereby diabetes influences CVD risk. Methods: Fibrin clots were formed from fibrinogen purified from 150 subjects with type 2 diabetes and varying degrees of glycaemic control (assessed by HbA 1 c), and from 50 matched control subjects. Clot structure was assessed by turbidity, permeation and confocal microscopy. The specific effect of glucose itself was assessed by analysing the structure of clots formed from purified fibrinogen in the presence of increasing concentrations of the sugar. Results: Clots formed by fibrinogen purified from type 2 diabetic subjects had a denser, less porous structure than those from control subjects. The structural changes found were related to the individual's glycaemic control; HbA 1 c correlated negatively with permeation coefficient (K s ) values (indicates clot pore size) (r=−0.57, p<0.0001) and positively with maximum absorbance (indicator of fibre size) (r=0.33, p<0.0001), branch point number (r=0.78, p<0.0001) and fibre density (r=0.63, p<0.0001). The ambient glucose level influenced clot structure; hypo-(<5 mmol) and hyperglycaemia (≥10 mmol/l) were both associated with a reduction in K s values and maximum absorbance, and with increased fibre density and branch point number within clots. Conclusions/ interpretation: The structural differences found to occur in type 2 diabetes and in association with hypo-and hyperglycaemia may confer increased resistance to fibrinolysis, and in consequence contribute to the increase in CVD risk in diabetic patients.

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Section: Discussionmentioning

confidence: 76%

The influence of type 2 diabetes on fibrin structure and function

2005

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“…However, its stratified analysis found a significant association between variability of FPG and all‐cause mortality in patients whose glucose control was poor 9. Indeed, a previous study showed that participants with low FPG levels also had a high risk of CVD and all‐cause mortality 2. Therefore, we suggest that not only FPG levels, but also longitudinal variability in FPG levels, predict a high risk of CVD and all‐cause mortality that is compatible or beyond mean FPG levels.…”

Section: Discussionmentioning

confidence: 97%

“…Management of fasting plasma glucose (FPG) levels associated with incident CVD and all‐cause mortality in the general population is an ongoing challenge for primary health care decision makers. Indeed, people with excessive high or low glucose levels have a high risk of CVD and all‐cause mortality 2, 3, 4, 5, 6, 7. Therefore, the main reason for CVD is thought to be not only chronic hyperglycemia or other traditional risk factors, but also frequent hypoglycemic and hyperglycemic episodes that accompany the disease's daily course.…”

Section: Introductionmentioning

confidence: 99%

Visit‐to‐Visit Variability of Fasting Plasma Glucose and the Risk of Cardiovascular Disease and All‐Cause Mortality in the General Population

Wang

Liu

et al. 2017

JAHA

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BackgroundThe association of short‐term variability of fasting plasma glucose (FPG) and mortality has been well investigated. However, the relationships between visit‐to‐visit variability of FPG over longer periods of follow‐up and cardiovascular disease (CVD) and all‐cause mortality are unclear. This study aimed to investigate these relationships.Methods and ResultsThe current analysis included 53 607 Chinese participants (mean age, 49.10 years) who were free of CVD in the Kailuan study. Participants were divided into 4 categories by quartiles of visit‐to‐visit variability of FPG. Visit‐to‐visit variability of FPG was defined as the coefficient of variation of 3 values of FPG that were measured from the examination periods of 2006 to 2007, 2008 to 2009, and 2010 to 2011. Cox proportional hazards models were used to calculate hazard ratios and 95% confidence intervals for CVD and all‐cause mortality. After a mean follow‐up of 4.93 years, 4261 individuals developed CVD and 1545 individuals died. The incidence of CVD and all‐cause mortality was 5.04 and 5.85 per 1000 person‐years, respectively. After adjusting for mean FPG and other potential confounders, individuals in the highest quartile of variability of FPG compared with participants in the lowest quartile showed a 26% greater risk of developing CVD (hazard ratio, 1.26; 95% confidence interval, 1.08–1.47) and a 46% greater risk for all‐cause mortality (hazard ratio, 1.46; 95% confidence interval, 1.25–1.70).ConclusionsIndependent of mean FPG and other baseline parameters, elevated visit‐to‐visit variability of FPG significantly increases the risk of CVD and all‐cause mortality in the general population. Measuring long‐term visit‐to‐visit variability of FPG is helpful for predicting the risk for CVD and all‐cause mortality.

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“…Very few studies allow evaluation of the newest extension of IFG down from 110 to 100 mg/dl (6.1-5.6 mmol/l) (3). Although the Rancho Bernardo men (20) showed a significant increase in mortality in that zone, the Rancho Bernardo women (18) and the Hoorn Study of men and women (27) did not. In the BLSA, we did not find an increased RR for mortality in men with FPG from 100 -110 mg/dl (5.6 -6.1 mmol/l).…”

Section: Baseline Characteristicsmentioning

confidence: 93%

“…The recommendations in the reports of 1979 (1) and 1985 (5) setting the cut points diagnostic for diabetes for the 2hPG concentration at 200 mg/dl (11.1 mmol/l) are clearly supported. The IGT zone of 140 -199 mg/dl (7.8 -11.0 mmol/l) also shows an increased RR for mortality; the Honolulu Heart Study (19) and the Rancho Bernardo men (20) are exceptions. Mortality risk in subjects in the normal glucose tolerance zone of Ͻ140 mg/dl (7.8 mmol/l) are quite variable.…”

Section: Baseline Characteristicsmentioning

confidence: 99%

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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Low Fasting Plasma Glucose Level as a Predictor of Cardiovascular Disease and All-Cause Mortality

Cited by 125 publications

References 24 publications

The influence of type 2 diabetes on fibrin structure and function

The influence of type 2 diabetes on fibrin structure and function

Visit‐to‐Visit Variability of Fasting Plasma Glucose and the Risk of Cardiovascular Disease and All‐Cause Mortality in the General Population

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

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