Blood glucose may be an alternative to cholesterol in CVD risk prediction charts

Area of Science:

• Cardiology
• Epidemiology
• Preventive Medicine

Background:

• Established cardiovascular disease (CVD) risk models incorporate factors like blood pressure, smoking, and cholesterol.
• The utility of total cholesterol for CVD risk prediction, especially in primary prevention, is debated.
• This study investigated glucose as a potential alternative to total cholesterol for predicting fatal CVD.

Purpose of the Study:

• To evaluate the predictive performance of fasting glucose compared to total cholesterol in models for fatal cardiovascular disease (CVD) risk.
• To determine if substituting total cholesterol with glucose improves CVD mortality prediction.
• To assess the clinical utility of glucose in established CVD risk assessment frameworks.

Main Methods:

• A cohort of 6,095 adults aged ≥16 years was followed from 1977-79 to 2008, with 727 CVD deaths recorded.
• Weibull regression, based on the ESC SCORE methodology, was employed using age, sex, blood pressure, smoking, and either fasting glucose or total cholesterol.
• Model performance was compared using Brier score (BS), area under the receiver-operating characteristic curve (AUC), and integrated discrimination improvement (IDI), with internal and external validation.

Main Results:

• Glucose demonstrated higher statistical significance (p < 0.001) in prediction models compared to total cholesterol (p = 0.046).
• The model incorporating glucose showed slightly superior predictive capacity (BS: 2216x10⁻⁵ vs. 2232x10⁻⁵; AUC: 0.9181 vs. 0.9169; IDI: 0.009, p=0.026).
• Glucose effectively discriminated overall CVD risk between high and low concentration groups, a finding confirmed by external validation.

Conclusions:

• Fasting glucose can serve as a valuable predictor of overall cardiovascular disease (CVD) mortality.
• Substituting total cholesterol with glucose in CVD risk prediction models may enhance accuracy.
• Glucose offers a promising alternative for improving risk stratification in cardiovascular disease prevention strategies.