Relation Between Blood Glucose and Coronary Mortality Over 33 Years in the Whitehall Study

Brunner, Eric J.

doi:10.2337/diacare.29.1.26

Cited by 22 publications

(28 citation statements)

References 15 publications

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“…To the best of our knowledge, this is the largest study using a range of techniques to evaluate, in the same study population, the nature and strength of the relationships between all these glucose measures and both all-cause and CVD mortality. Our finding of a continuous graded relationship between 2hPG and CVD mortality concurs with some [3,4,12] but not all studies [6,10]. Balkau et al [10] reported a J-shaped relationship for CVD mortality.…”

Section: Discussionsupporting

confidence: 77%

“…Balkau et al [10] reported a J-shaped relationship for CVD mortality. Furthermore, others have reported a threshold relationship, where the risk of fatal and/or non-fatal CVD only increased in the upper range of the 2hPG distribution [6]. For all-cause mortality, we also observed a graded continuous relationship for 2hPG.…”

Section: Discussionsupporting

confidence: 56%

“…The DECODE study, a meta-analysis of individual data from different cohorts, combined different blood sample types and this may have introduced measurement imprecision [12]. Our study included men and women aged ≥25 years and used a 75 g OGTT, whereas other findings were based on men only, [10] or used a 50 g OGTT [6].…”

Section: Discussionmentioning

confidence: 94%

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Continuous relationships between non-diabetic hyperglycaemia and both cardiovascular disease and all-cause mortality: the Australian Diabetes, Obesity, and Lifestyle (AusDiab) study

et al. 2009

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Aims/hypothesis Hyperglycaemia is a risk factor for cardiovascular disease (CVD) and all-cause mortality in individuals without diabetes. We investigated: (1) whether the risk of allcause and CVD mortality extended continuously throughout the range of fasting plasma glucose (FPG), 2 h plasma glucose (2hPG) and HbA 1c values; and (2) the ability of these measures to improve risk prediction for mortality. Methods Data on 10,026 people aged ≥25 years without diagnosed diabetes were obtained from the population-based Australian Diabetes, Obesity and Lifestyle study. Between 1999 and 2000, FPG, 2hPG and HbA 1c were assessed and allcause (332 deaths) and CVD (88 deaths) mortality were obtained after 7 years. Results Both 2hPG and HbA 1c exhibited linear relationships with all-cause and CVD mortality, whereas FPG showed Jshaped relationships. The adjusted HR (95% CI) for all-cause mortality per SD increase was 1.2 (1.1-1.3) for 2hPG and 1.1 (1.0-1.2) for HbA 1c . The HR for FPG <5.1 mmol/l (per SD decrease) was 2.0 (1.3-3.0); for FPG ≥5.1 mmol/l (per SD increase) the HR was 1.1 (1.0-1.2). Corresponding HRs for CVD mortality were 1.2 (1.0-1.4), 1.2 (1.0-1.3), 4.0 (2.1-7.6) and 1.3 (1.1-1.4). The discriminative ability of each measure was similar; no measure substantially improved individual risk identification over traditional risk factors. Conclusions/interpretation In individuals without diagnosed diabetes, 2hPG and FPG, but not HbA 1c were significant predictors of all-cause mortality, whereas all measures were significant predictors of CVD mortality. However, these glucose measures did not substantially improve individual risk identification.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionsupporting

confidence: 56%

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Continuous relationships between non-diabetic hyperglycaemia and both cardiovascular disease and all-cause mortality: the Australian Diabetes, Obesity, and Lifestyle (AusDiab) study

et al. 2009

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“…We considered the relationship between CBG and CVD risk as continuous, rather than being determined by a threshold. Thus, similarly to blood pressure [31][32][33], lower CBG may yield lower CVD mortality rates, as some epidemiological studies have shown in meta-analyses with fasting blood glucose [34] or in other studies with OGTT [9,35].…”

Section: Discussionmentioning

confidence: 99%

“…Thus, the question of whether a casual blood glucose (CBG) level, whose value can be obtained at any time of the day regardless of time since last meal, can predict CHD or CVD mortality is of great interest. Only one prospective study has reported this relationship between CBG and CHD [6], though some prospective studies have reported the relationship between CHD and fasting blood glucose or OGTT [7][8][9]. We investigated the relationship of CBG with CHD, CVD and all-cause mortality in a 17.3-year follow-up study with a representative sample from the Japanese population.…”

Section: Introductionmentioning

confidence: 99%

Relationship of elevated casual blood glucose level with coronary heart disease, cardiovascular disease and all-cause mortality in a representative sample of the Japanese population. NIPPON DATA80

et al. 2008

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Aims/hypothesis High fasting blood glucose is one of the well-known risk factors for CHD. However, in certain settings, patients cannot always be expected to fast. For example, community screenings for cardiovascular disease (CVD) risk factors in Japan are performed under non-fasting conditions to achieve high participation rates. Thus, we examined a representative cohort of the Japanese population (n=9,444, follow-up period 17.3 years) to clarify whether high casual blood glucose (CBG) can predict CVD mortality. Methods We defined CBG groups as follows: high CBG≥ 11.1 mmol/l or participants with a history of diabetes mellitus; borderline high, 7.77≤CBG<11.1 mmol/l; higher normal, 5.22≤CBG<7.77 mmol/l); and lower normal, CBG<5.22 mmol/l. The multivariate-adjusted hazard ratios (HRs) for CHD, CVD and all-cause mortality were calculated. Results The crude CHD mortality rate was 0.84 per 1,000 person-years. Age-and sex-adjusted HRs for CHD mortality were high among participants with CBG levels ≥7.77 mmol/l, regardless of time since last meal. Multivariate-adjusted HRs (95% CI) of CHD mortality in high and borderline high CBG groups were 2.62 (1.46-4.67) and 2.43 (1.29-4.58), respectively. Similar results were observed for both CVD Diabetologia (2008) and all-cause mortality. Even within the normal blood glucose range, each 1 mmol/l increase in CBG was associated with a statistically significant increase in the HR for CVD mortality (1.12, 95% CI 1.02-1.22). Population-attributable fractions of the combined groups of high and borderline high CBG for CHD, CVD and all-cause mortality were 12.0, 4.9 and 3.5%, respectively. Conclusions/interpretation Increases in CBG, even within the normal range, predict CVD mortality.51:575-582 DOI 10.1007/s00125-007-0915-6 Electronic supplementary

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A Palaeolithic diet improves glucose tolerance more than a Mediterranean-like diet in individuals with ischaemic heart disease

et al. 2007

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Aims/hypothesis Most studies of diet in glucose intolerance and type 2 diabetes have focused on intakes of fat, carbohydrate, fibre, fruits and vegetables. Instead, we aimed to compare diets that were available during human evolution with more recently introduced ones. Methods Twenty-nine patients with ischaemic heart disease plus either glucose intolerance or type 2 diabetes were randomised to receive (1) a Palaeolithic ('Old Stone Age') diet (n=14), based on lean meat, fish, fruits, vegetables, root vegetables, eggs and nuts; or (2) a Consensus (Mediterranean-like) diet (n=15), based on whole grains, low-fat dairy products, vegetables, fruits, fish, oils and margarines. Primary outcome variables were changes in weight, waist circumference and plasma glucose AUC (AUC Glucose 0-120 ) and plasma insulin AUC (AUC Insulin 0-120 ) in OGTTs. Results Over 12 weeks, there was a 26% decrease of AUC Glucose 0-120 (p=0.0001) in the Palaeolithic group and a 7% decrease (p=0.08) in the Consensus group. The larger (p= 0.001) improvement in the Palaeolithic group was independent (p=0.0008) of change in waist circumference (−5.6 cm in the Palaeolithic group, −2.9 cm in the Consensus group; p=0.03). In the study population as a whole, there was no relationship between change in AUC Glucose 0-120 and changes in weight (r=−0.06, p=0.9) or waist circumference (r=0.01, p=1.0). There was a tendency for a larger decrease of AUC Insulin 0-120 in the Palaeolithic group, but because of the strong association between change in AUC Insulin 0-120 and change in waist circumference (r=0.64, p=0.0003), this did not remain after multivariate analysis. Conclusions/interpretation A Palaeolithic diet may improve glucose tolerance independently of decreased waist circumference.

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Relation Between Blood Glucose and Coronary Mortality Over 33 Years in the Whitehall Study

Abstract: A threshold model with linear slope best described the dose-response relationship between postload blood glucose and CHD mortality risk.

Cited by 22 publications

References 15 publications

Continuous relationships between non-diabetic hyperglycaemia and both cardiovascular disease and all-cause mortality: the Australian Diabetes, Obesity, and Lifestyle (AusDiab) study

Continuous relationships between non-diabetic hyperglycaemia and both cardiovascular disease and all-cause mortality: the Australian Diabetes, Obesity, and Lifestyle (AusDiab) study

Relationship of elevated casual blood glucose level with coronary heart disease, cardiovascular disease and all-cause mortality in a representative sample of the Japanese population. NIPPON DATA80

A Palaeolithic diet improves glucose tolerance more than a Mediterranean-like diet in individuals with ischaemic heart disease

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