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Markers of Dysglycaemia and Risk of Coronary Heart Disease in People without Diabetes: Reykjavik Prospective Study and Systematic Review


Background:
Associations between circulating markers of dysglycaemia and coronary heart disease (CHD) risk in people without diabetes have not been reliably characterised. We report new data from a prospective study and a systematic review to help quantify these associations.

Methods and Findings:
Fasting and post-load glucose levels were measured in 18,569 participants in the population-based Reykjavik study, yielding 4,664 incident CHD outcomes during 23.5 y of mean follow-up. In people with no known history of diabetes at the baseline survey, the hazard ratio (HR) for CHD, adjusted for several conventional risk factors, was 2.37 (95% CI 1.79–3.14) in individuals with fasting glucose ≥7.0 mmol/l compared to those <7 mmol/l. At fasting glucose values below 7 mmol/l, adjusted HRs were 0.95 (0.89–1.01) per 1 mmol/l higher fasting glucose and 1.03 (1.01–1.05) per 1 mmol/l higher post-load glucose. HRs for CHD risk were generally modest and nonsignificant across tenths of glucose values below 7 mmol/l. We did a meta-analysis of 26 additional relevant prospective studies identified in a systematic review of Western cohort studies that recorded fasting glucose, post-load glucose, or glycated haemoglobin (HbA1c) levels. In this combined analysis, in which participants with a self-reported history of diabetes and/or fasting blood glucose ≥7 mmol/l at baseline were excluded, relative risks for CHD, adjusted for several conventional risk factors, were: 1.06 (1.00–1.12) per 1 mmol/l higher fasting glucose (23 cohorts, 10,808 cases, 255,171 participants); 1.05 (1.03–1.07) per 1 mmol/l higher post-load glucose (15 cohorts, 12,652 cases, 102,382 participants); and 1.20 (1.10–1.31) per 1% higher HbA1c (9 cohorts, 1639 cases, 49,099 participants).

Conclusions:
In the Reykjavik Study and a meta-analysis of other Western prospective studies, fasting and post-load glucose levels were modestly associated with CHD risk in people without diabetes. The meta-analysis suggested a somewhat stronger association between HbA1c levels and CHD risk.

: Please see later in the article for the Editors' Summary


Vyšlo v časopise: Markers of Dysglycaemia and Risk of Coronary Heart Disease in People without Diabetes: Reykjavik Prospective Study and Systematic Review. PLoS Med 7(5): e32767. doi:10.1371/journal.pmed.1000278
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pmed.1000278

Souhrn

Background:
Associations between circulating markers of dysglycaemia and coronary heart disease (CHD) risk in people without diabetes have not been reliably characterised. We report new data from a prospective study and a systematic review to help quantify these associations.

Methods and Findings:
Fasting and post-load glucose levels were measured in 18,569 participants in the population-based Reykjavik study, yielding 4,664 incident CHD outcomes during 23.5 y of mean follow-up. In people with no known history of diabetes at the baseline survey, the hazard ratio (HR) for CHD, adjusted for several conventional risk factors, was 2.37 (95% CI 1.79–3.14) in individuals with fasting glucose ≥7.0 mmol/l compared to those <7 mmol/l. At fasting glucose values below 7 mmol/l, adjusted HRs were 0.95 (0.89–1.01) per 1 mmol/l higher fasting glucose and 1.03 (1.01–1.05) per 1 mmol/l higher post-load glucose. HRs for CHD risk were generally modest and nonsignificant across tenths of glucose values below 7 mmol/l. We did a meta-analysis of 26 additional relevant prospective studies identified in a systematic review of Western cohort studies that recorded fasting glucose, post-load glucose, or glycated haemoglobin (HbA1c) levels. In this combined analysis, in which participants with a self-reported history of diabetes and/or fasting blood glucose ≥7 mmol/l at baseline were excluded, relative risks for CHD, adjusted for several conventional risk factors, were: 1.06 (1.00–1.12) per 1 mmol/l higher fasting glucose (23 cohorts, 10,808 cases, 255,171 participants); 1.05 (1.03–1.07) per 1 mmol/l higher post-load glucose (15 cohorts, 12,652 cases, 102,382 participants); and 1.20 (1.10–1.31) per 1% higher HbA1c (9 cohorts, 1639 cases, 49,099 participants).

Conclusions:
In the Reykjavik Study and a meta-analysis of other Western prospective studies, fasting and post-load glucose levels were modestly associated with CHD risk in people without diabetes. The meta-analysis suggested a somewhat stronger association between HbA1c levels and CHD risk.

: Please see later in the article for the Editors' Summary


Zdroje

1. GoldsteinDE

LittleRR

LorenzRA

MaloneJI

NathanDM

2003 Tests of glycemia in diabetes. Diabetes Care 26 Suppl 1 S106 8

2. BeckmanJA

CreagerMA

LibbyP

2002 Diabetes and atherosclerosis: epidemiology, pathophysiology, and management. JAMA 287 2570 81

3. CoutinhoM

GersteinHC

WangY

YusufS

1999 The relationship between glucose and incident cardiovascular events. A metaregression analysis of published data from 20 studies of 95,783 individuals followed for 12.4 years. Diabetes Care 22 233 40

4. LevitanEB

SongY

FordES

LiuS

2004 Is nondiabetic hyperglycemia a risk factor for cardiovascular disease? A meta-analysis of prospective studies. Arch Intern Med 164 2147 55

5. DECODE Study Group, the European Diabetes Epidemiology Group 2001 Glucose tolerance and cardiovascular mortality: comparison of fasting and 2-hour diagnostic criteria. Arch Intern Med 161 397 405

6. HelfandM

BuckleyDI

FreemanM

FuR

RogersK

2009 Emerging risk factors for coronary heart disease: a summary of systematic reviews conducted for the U.S. Preventive Services Task Force. Ann Intern Med 151 496 507

7. UlmerH

KelleherC

DiemG

ConcinH

2004 Why Eve is not Adam: prospective follow-up in 149650 women and men of cholesterol and other risk factors related to cardiovascular and all-cause mortality. J Womens Health (Larchmt) 13 41 53

8. EberlyLE

PrineasR

CohenJD

VazquezG

ZhiX

2006 Metabolic syndrome: risk factor distribution and 18-year mortality in the multiple risk factor intervention trial. Diabetes Care 29 123 30

9. SmithNL

BarzilayJI

ShafferD

SavagePJ

HeckbertSR

2002 Fasting and 2-hour postchallenge serum glucose measures and risk of incident cardiovascular events in the elderly: the Cardiovascular Health Study. Arch Intern Med 162 209 16

10. SaydahSH

MiretM

SungJ

VarasC

GauseD

2001 Postchallenge hyperglycemia and mortality in a national sample of U.S. adults. Diabetes Care 24 1397 402

11. Cruz-VidalM

Garcia-PalmieriMR

CostasRJr

SorliePD

HavlikRJ

1983 Abnormal blood glucose and coronary heart disease: the Puerto Rico Heart Health Program. Diabetes Care 6 556 61

12. FerrieJE

Singh-ManouxA

KivimäkiM

MindellJ

BreezeE

2009 Cardiorespiratory risk factors as predictors of 40-year mortality in women and men. Heart 95 1250 7

13. WelbornTA

WearneK

1979 Coronary heart disease incidence and cardiovascular mortality in Busselton with reference to glucose and insulin concentrations. Diabetes Care 2 154 60

14. Scheidt-NaveC

Barrett-ConnorE

WingardDL

CohnBA

EdelsteinSL

1991 Sex differences in fasting glycemia as a risk factor for ischemic heart disease death. Am J Epidemiol 133 565 76

15. OnatA

HergençG

CanG

2007 Prospective validation in identical Turkish cohort of two metabolic syndrome definitions for predicting cardiometabolic risk and selection of most appropriate definition. Anadolu Kardiyol Derg 7 29 34

16. BalkauB

ShipleyM

JarrettRJ

PyoralaK

PyoralaM

1998 High blood glucose concentration is a risk factor for mortality in middle-aged nondiabetic men. 20-year follow-up in the Whitehall Study, the Paris Prospective Study, and the Helsinki Policemen Study. Diabetes Care 21 360 7

17. YarnellJW

PickeringJE

ElwoodPC

BakerIA

BaintonD

1994 Does non-diabetic hyperglycemia predict future IHD? Evidence from the Caerphilly and Speedwell studies. J Clin Epidemiol 47 383 8

18. WangJ

RuotsalainenS

MoilanenL

LepistöP

LaaksoM

2007 The metabolic syndrome predicts cardiovascular mortality: a 13-year follow-up study in elderly non-diabetic Finns. Eur Heart J 28 857 64

19. SternMP

FatehiP

WilliamsK

HaffnerSM

2002 Predicting future cardiovascular disease: do we need the oral glucose tolerance test? Diabetes Care 25 1851 6

20. SelvinE

CoreshJ

GoldenSH

BrancatiFL

FolsomAR

2005 Glycemic control and coronary heart disease risk in persons with and without diabetes: the atherosclerosis risk in communities study. Arch Intern Med 165 1910 6

21. BjornholtJV

ErikssenG

AaserE

SandvikL

Nitter-HaugeS

1999 Fasting blood glucose: an underestimated risk factor for cardiovascular death. Results from a 22-year follow-up of healthy nondiabetic men. Diabetes Care 22 45 9

22. RodriguezBL

LauN

BurchfielCM

AbbottRD

SharpDS

1999 Glucose intolerance and 23-year risk of coronary heart disease and total mortality: the Honolulu Heart Program. Diabetes Care 22 1262 5

23. PyöräläM

MiettinenH

HalonenP

LaaksoM

PyöräläK

2000 Insulin resistance syndrome predicts the risk of coronary heart disease and stroke in healthy middle-aged men: the 22-year follow-up results of the Helsinki Policemen Study. Arterioscler Thromb Vasc Biol 20 38 44

24. MarinA

MedranoMJ

GonzalezJ

PintadoH

CompairedV

2006 Risk of ischaemic heart disease and acute myocardial infarction in a Spanish population: observational prospective study in a primary-care setting. BMC Public Health 6 38

25. MeigsJB

NathanDM

D'AgostinoRBSr

Wilson PW; Framingham Offspring Study. 2002 Fasting and postchallenge glycemia and cardiovascular disease risk: the Framingham Offspring Study. Diabetes Care 25 1845 50

26. LawlorDA

SmithGD

EbrahimS

2006 Does the new International Diabetes Federation definition of the metabolic syndrome predict CHD any more strongly than older definitions? Findings from the British Women's Heart and Health Study. Diabetologia 49 41 8

27. AdamsRJ

AppletonSL

HillCL

WilsonDH

TaylorAW

2009 Independent association of HbA(1c) and incident cardiovascular disease in people without diabetes. Obesity (Silver Spring) 17 559 63

28. BarrEL

ZimmetPZ

WelbornTA

JolleyD

MaglianoDJ

2007 Risk of cardiovascular and all-cause mortality in individuals with diabetes mellitus, impaired fasting glucose, and impaired glucose tolerance: the Australian Diabetes, Obesity, and Lifestyle Study (AusDiab). Circulation 116 151 7

29. BrunnerEJ

ShipleyMJ

WitteDR

FullerJH

Marmot MG. 2006 Relation between blood glucose and coronary mortality over 33 years in the Whitehall Study. Diabetes Care 29 26 31

30. OrenciaAJ

DaviglusML

DyerAR

WalshM

GreenlandP

1997 One-hour postload plasma glucose and risks of fatal coronary heart disease and stroke among nondiabetic men and women: the Chicago Heart Association Detection Project in Industry (CHA) Study. J Clin Epidemiol 50 1369 76

31. KhawKT

WarehamN

BinghamS

LubenR

WelchA

2004 Association of haemoglobin A1c with cardiovascular disease and mortality in adults: the European prospective investigation into cancer in Norfolk. Ann Intern Med 141 413 20

32. JonsdottirLS

SigfussonN

GudnasonV

SigvaldasonH

ThorgeirssonG

2002 Do lipids, blood pressure, diabetes, and smoking confer equal risk of myocardial infarction in women as in men? The Reykjavik Study. J Cardiovasc Risk 9 67 76

33. HoffmanWS

1973 Rapid photoelectric method for the determination of glucose in blood and urine. J Biol Chem 120 51 4

34. EastonDF

PetoJ

BabikerAG

1991 Floating absolute risk: an alternative to relative risk in survival and case-control analysis avoiding an arbitrary reference group. Stat Med 10 1025 35

35. ClarkeR

ShipleyM

LewingtonS

YoungmanL

CollinsR

1999 Underestimation of risk associations due to regression dilution in long-term follow-up of prospective studies. Am J Epidemiol 150 341 353

36. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus 2003 Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care 26 3160 7

37. HigginsJP

ThompsonSG

DeeksJJ

AltmanDG

2003 Measuring inconsistency in meta-analyses. BMJ 327 557 60

38. EggerM

Davey SmithG

SchneiderM

Minder C 1997 Bias in meta-analysis detected by a simple, graphical test. BMJ 315 629 34

39. WHO consultation report. Definition, diagnosis and classification of diabetes mellitus and its complications. WHO/NCD/NCS/ 91.2

40. Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC); European Association for the Study of Diabetes (EASD). 2007 Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary. Eur Heart J 28 88 136

41. KahnR

BuseJ

FerranniniE

SternM

2005 The metabolic syndrome: time for a critical appraisal: joint statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 28 2289 304

42. DanaeiG

LawesCM

Vander HoornS

MurrayCJ

Ezzati M 2006 Global and regional mortality from ischaemic heart disease and stroke attributable to higher-than-optimum blood glucose concentration: comparative risk assessment. Lancet 368 1651 9

43. AvendanoM

MackenbachJP

2006 Blood glucose levels: facing a global crisis. Lancet 368 1631 2

44. GersteinH

YusufS

RiddleMC

RydenL

Origin Trial Investigators 2008 Rationale, design, and baseline characteristics for a large international trial of cardiovascular disease prevention in people with dysglycemia: the ORIGIN Trial (Outcome Reduction with an Initial Glargine Intervention). Am Heart J 155 26 32

45. HolmanRR

2007 A new era in the secondary prevention of CVD in prediabetes - the Acarbose Cardiovascular Evaluation (ACE) trial. Diab Vasc Dis Res 4Suppl 1 S40

46. DagenaisGR

GersteinHC

HolmanR

BudajA

DREAM Trial Investigators 2008 Effects of ramipril and rosiglitazone on cardiovascular and renal outcomes in people with impaired glucose tolerance or impaired fasting glucose: results of the Diabetes REduction Assessment with ramipril and rosiglitazone Medication (DREAM) trial. Diabetes Care 31 1007 1014

47. The NAVIGATOR Study Group, Holman RR, Haffner SM, McMurray JJ, et al. 2010 Effect of Nateglinide on the Incidence of Diabetes and Cardiovascular Events. N Engl J Med 362 1463 1476

48. KhawKT

WarehamN

2006 Glycated haemoglobin as a marker of cardiovascular risk. Curr Opin Lipidol 17 637 43

49. SungJ

SongYM

EbrahimS

LawlorDA

2009 Fasting blood glucose and the risk of stroke and myocardial infarction. Circulation 119 812 9

50. PreissD

WelshP

MurrayHM

ShepherdJ

PackardC

2010 Fasting plasma glucose in non-diabetic participants and the risk for incident cardiovascular events, diabetes, and mortality: results from WOSCOPS 15-year follow-up. Eur Heart J. Epub ahead of print doi:10.1093/eurheartj/ehq095

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