Abstract
BackgroundFasting plasma glucose (FPG) and 2-h post challenge plasma glucose (2 h-PCPG), whether as continuous or categorical variables, are associated with incident cardiovascular disease (CVD) and diabetes; however, their role among patients with existing CVD is a matter of debate. We aimed to evaluate associations of different glucose intolerance states with recurrent CVD and incident diabetes among subjects with previous CVD.MethodsFrom a prospective population-based cohort, 408 Iranians aged ≥ 30 years, with history of CVD and without known diabetes were included. Associations of impaired fasting glucose (IFG) according to the American Diabetes Association (ADA) and World Health Organization (WHO) criteria, impaired glucose tolerance (IGT), newly diagnosed diabetes (NDM) with outcomes of interest were determined by multivariable Cox proportional hazard models after adjustment for traditional risk factors. Furthermore, FPG and 2 h-PCPG were entered as continuous variables.ResultsOver a decade of follow-up, 220 CVD events including 89 hard events (death, myocardial infarction and stroke) occurred. Regarding prediabetes, only IFG-ADA was associated with increased risk of hard CVD [hazard ratio(HR), 95%CI: 1.62,1.03–2.57] in the age-sex adjusted model. In patients with NDM, those with FPG ≥ 7 mmol/L were at higher risk of incident CVD/coronary heart disease(CHD) and their related hard outcomes (HR ranged from 1.89 to 2.84, all P < 0.05). Moreover, those with 2 h-PCPG ≥ 11.1 mmol/L had significant higher risk of CVD (1.46,1.02–2.11), CHD (1.46,1.00–2.15) and hard CHD (1.95:0.99–3.85, P = 0.05). In the fully adjusted model, each 1 SD increase in FPG was associated with 20, 27, 15 and 25% higher risk of CVD, hard CVD, CHD and hard CHD, respectively; moreover each 1 SD higher 2 h-PCPG was associated with 21% and 16% higher risk of CVD, and CHD, respectively. Among individuals free of diabetes at baseline (n = 361), IFG-ADA, IFG-WHO and IGT were significantly associated with incident diabetes (all P < 0.05); significant associations were also found for FPG and 2 h-PCPG as continuous variables (all HRs for 1-SD increase > 2, P < 0.05).ConclusionsAmong subjects with stable CVD, NDM whether as high FPG or 2 h-PCPG, but not pre-diabetes status was significantly associated with CVD/CHD and related hard outcomes.
Highlights
Cardiovascular disease (CVD) is one of the highburden diseases in the Middle East and North Africa (MENA) region and specially among Iranian population [1]
Associations between prediabetes and newly diagnosed diabetes mellitus (NDM) with recurrent cardiovascular disease (CVD) have been assessed in some shortand long-term hospital-based studies with inconsistent findings [9,10,11,12]; These studies were performed among patients with history of myocardial infarction (MI), coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), heart failure (HF) [13] or history of acute coronary syndrome (ACS)
We aimed to investigate the associations between Fasting plasma glucose (FPG) and 2 h-post challenge plasma glucose (2 2-H post challenge plasma glucose (h-PCPG)), whether as continuous or categorical variables, with subsequent CVD/coronary heart disease (CHD) events and related hard outcomes as well as incident type 2 diabetes among Iranian subjects with stable CVD and without known diabetes from the Tehran Lipid and Glucose Study (TLGS), the oldest population-based cohort of MENA region
Summary
Cardiovascular disease (CVD) is one of the highburden diseases in the Middle East and North Africa (MENA) region and specially among Iranian population [1]. Associations between prediabetes and NDM with recurrent CVD have been assessed in some shortand long-term hospital-based studies with inconsistent findings [9,10,11,12]; These studies were performed among patients with history of myocardial infarction (MI), coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), HF [13] or history of acute coronary syndrome (ACS) According to these studies, Ryden et al [14] strongly recommend using oral glucose tolerance test (OGTT) for all patients with coronary artery disease (CAD) without known dysglycemia to improve the prediction of recurrent CV events.
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