Development of coronary heart disease and ischemic stroke in relation to fasting and 2-hour plasma glucose levels in the normal range

John S Yudkin,Coen DA Stehouwer,Decode Finnish And Swedish Study Investigators ,Jaakko Tuomilehto,Lei Zhang,Jacqueline M Dekker,Tiina Laatikainen,Altan Onat,Kalevi Pyörälä,Feng Ning,Qing Qiao

doi:10.1186/1475-2840-11-76

Abstract

BackgroundIndividuals who had normoglycemia but whose 2-hour plasma glucose (2hPG) concentrations did not return to the fasting plasma glucose (FPG) levels during an oral glucose tolerance test (OGTT) have been shown to have increased cardiovascular mortality. This is further investigated regarding to the first events of coronary heart disease (CHD) and ischemic stroke (IS).MethodData from 9 Finnish and Swedish cohorts comprising 3743 men and 3916 women aged 25 to 90 years who had FPG < 6.1 mmol/l and 2hPG < 7.8 mmol/l and free of CVD at enrolment were analyzed. Hazard ratios (HRs) for first CHD and IS events were estimated for the individuals with 2hPG > FPG (Group II) compared with those having 2hPG ≤ FPG (Group I).ResultsA total of 466 (115) CHD and 235 (106) IS events occurred in men (women) during a median follow-up of 16.4 years. Individuals in Group II were older and had greater body mass index, blood pressure, 2hPG and fasting insulin than those in Group I in both sexes. Multivariate adjusted HRs (95% confidence intervals) for incidence of CHD, IS, and composite CVD events (CHD + IS) in men were 1.13 (0.93-1.37), 1.40 (1.06-1.85) and 1.20 (1.01-1.42) in the Group II as compared with those in the Group I. The corresponding HRs in women were 1.33 (0.83-2.13), 0.94 (0.59-1.51) and 1.11 (0.79-1.54), respectively.ConclusionWithin normoglycemic range individuals whose 2hPG did not return to their FPG levels during an OGTT had increased risk of CHD and IS.

Highlights

Individuals who had normoglycemia but whose 2-hour plasma glucose (2hPG) concentrations did not return to the fasting plasma glucose (FPG) levels during an oral glucose tolerance test (OGTT) have been shown to have increased cardiovascular mortality
Within normoglycemic range individuals whose 2hPG did not return to their FPG levels during an OGTT had increased risk of coronary heart disease (CHD) and ischemic stroke (IS)
The incidence of IS, composite Cardiovascular disease (CVD) events were higher in the Group II than in the Group I in men (p < 0.05), but not in women (Table 2)

Summary

Introduction

Individuals who had normoglycemia but whose 2-hour plasma glucose (2hPG) concentrations did not return to the fasting plasma glucose (FPG) levels during an oral glucose tolerance test (OGTT) have been shown to have increased cardiovascular mortality. This is further investigated regarding to the first events of coronary heart disease (CHD) and ischemic stroke (IS). Two-hour plasma glucose (2hPG) is a better predictor than fasting plasma glucose (FPG) for incidence of CHD [8,9] and ischemic stroke (IS) [10] among individuals with hyperglycemia, but little is known about their impact within normoglycemic range. To further clarify the causal relationship between elevated normal 2hPG and the development of the CVD events, the current study is carried out based on the Finnish and the Swedish DECODE cohorts who have complete information on the occurrence of both fatal and nonfatal events

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Conclusion