The effect of change in fasting glucose on the risk of myocardial infarction, stroke, and all-cause mortality: a nationwide cohort study

Abstract

BackgroundThe effect of change in blood glucose levels on the risk of cardiovascular disease among individuals without diabetes is currently unclear. We aimed to examine the association of change in fasting serum glucose with incident cardiovascular disease and all-cause mortality among representative large population.MethodsWe analyzed the data from retrospective cohort of Korean National Health Insurance Service. In total, 260,487 Korean adults aged over 40 years, without diabetes mellitus and cardiovascular disease at baseline measured change in fasting serum glucose according to the criteria of impaired and diabetic fasting glucose status: normal fasting glucose (NFG, fasting glucose: < 100 mg/dL), impaired fasting glucose (IFG, fasting glucose: 100.0–125.9 mg/dL), and diabetic fasting glucose (DFG, fasting glucose: ≥ 126.0 mg/dL). Compared to the persistently unchanged group (i.e. NFG to NFG or IFG to IFG), Cox proportional hazards regression analyses were performed in the changed group to obtain the hazards ratio (HR) with 95% confidence interval (CI) for the subsequent median 8-year myocardial infarction, stroke, and all-cause mortality.ResultsCompared to individuals with persistent NFG (i.e., NFG to NFG), individuals who shifted from NFG to DFG had an increased risk of stroke (HR [95% CI]: 1.19 [1.02–1.38]) and individuals who shifted from NFG to IFG or DFG had increased risks of all-cause mortality (HR [95% CI]: 1.08 [1.02–1.14] for NFG to IFG and 1.56 [1.39–1.75] for NFG to DFG). Compared to individuals with persistent IFG, individuals who shifted from IFG to DFG had an increased risk of MI and all-cause mortality (HR [95% CI]: 1.65 [1.20–2.27] and 1.16 [1.02–1.33], respectively).ConclusionsIncreasing fasting glucose in non-diabetic population is associated with risks of the MI, stroke, and all-cause mortality, which is more rapid, more severe.Electronic supplementary materialThe online version of this article (10.1186/s12933-018-0694-z) contains supplementary material, which is available to authorized users.

The sweet spot: fasting glucose, cardiovascular disease, and mortality in older adults with diabetes: a nationwide population-based study

“…Consistent with our study, several previous studies have demonstrated the J-shaped relationship between fasting glucose level and adverse outcomes, including all-cause mortality and CV events, not only in people with diabetes but also in the healthy population [12][13][14][15]. Recent meta-analyses and a nationwide observational study revealed an increased risk of CV event in adults with prediabetes even in fasting glucose range (100-125 mg/dL) [16,17]. On the contrary, our study showed that the fasting glucose range of 95-124 mg/dL seemed to be optimal for the prevention of CV events in patients with diabetes.…”

Change in glucose intolerance status and risk of incident cardiovascular disease: Tehran Lipid and Glucose Study

“…Our results regarding the association between incident IFG and risk of CVD, were in line with those of a Korean population [11] showing no higher hazard for CVD. Moreover, in our study we found an unexpected finding regarding those with NFG/NGT who converted to IFG/ IGT that showed 28% lower risk of CVD.…”

“…Nevertheless, the results were on the basis of a "snapshot" measurement of blood glucose, and the authors did not consider isolated IFG and IGT groups. A few studies with varying estimates of the CVD risk have assessed the impact of IFG/IGT with or without conversion to diabetes [8][9][10][11]; however, it's difficult to compare the results due to the different sample size, age Table 2 HRs (95% (CI) of CVD and CHD for subjects with incident IR and those with changing IR status between baseline and the first follow-up (n = 803) Incident IR, those who converted from IS state to IR state. IR and IS among men was defined as HOMA-IR ≥ 2.17 µU/mL and < 2.17 µU/mL, respectively; corresponding values form women were ≥ 1.85 µU/mL and < 1.85 µU/mL respectively [23] IR, insulin resistance; IS, insulin sensitive; HR, hazard ratios; CI, confidence interval; CVD, cardiovascular disease; CHD, coronary heart disease a Model 1: Age, sex of participants, duration of changes in glucose category states and type and number of confounders [26].…”

“…Some studies conducted among European, Korean and American populations have assessed this issue; some showed an increased risk of CVD in the presence of IFG and/or IGT per se (i.e. without changing to diabetes state) [8,9], while others showed this risk was increased only after progression to type 2 diabetes [10,11].…”

Phenotyping Individuals With Newly-Diagnosed Type 2 Diabetes at Risk for All-Cause Mortality: A Single Centre Observational, Prospective Study

“…Real-life observations performed in large cohorts of T2D individuals indicate a variable mortality rate, higher in the Western countries [15][16][17] and lower in Arab countries [18], and declining over the last decade [19]; diabetes duration is, indeed, one of the main determinants of such risk [20,21]. In our small sample we show that, despite the intensive treatment of all risk factors and comorbidities, the mortality rate of the patients over the rst ve years of known disease is superimposable to that of patients with much higher diabetes duration and prevalence of comorbidities, con rming the relative weight of prediabetes state in determining a higher CV and, of less extent, mortality risk [10,22,23]. Another possibility could be a short-term negative effect on mortality that follows the diagnosis of diabetes in older adults; such phenomenon was not reported in the large subset of the Kaiser Permanente Northern California with the same age of our patients and a short diabetes duration, where the mortality rate was 19.61/1000 patients/year [24].…”