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Prospective Study of Fasting Blood Glucose and Intracerebral Hemorrhagic Risk
Cheng Jin1, Guohong Li1, Kathryn M Rexrode1
1From the Department of Cardiology (C.J., C.R., Y.W., S.W.), Department of Neurology (X.Y.), and Department of Medical Imaging (Y.H.), Kailuan General Hospital, Tangshan, China; Department of Nutritional Sciences, State College, Pennsylvania State University, University Park (C.J., X.G.); School of Public Health, Shanghai Jiao Tong University School of Medicine, China (G.L.); Division of Preventive Medicine (K.R.) and Division of Endocrinology, Diabetes, and Hypertension (A.V.), Brigham and Women's Hospital, Boston, MA; and Hemorrhagic Stroke Research Program, Massachusetts General Hospital, Harvard Medical School, Boston (M.E.G.).
Insights
Both low and high fasting blood glucose levels increase the risk of intracerebral hemorrhage (ICH). Maintaining blood glucose within the normal range is crucial for preventing this serious type of stroke.
Area of Science:
- Neurology
- Endocrinology
- Public Health
Background:
- Diabetes mellitus is a known risk factor for ischemic stroke.
- The link between fasting blood glucose and intracerebral hemorrhage (ICH) risk is not well-established.
- Previous research shows inconsistent associations between blood glucose levels and ICH.
Purpose of the Study:
- To investigate the long-term impact of fasting blood glucose (FBG) on the risk of incident intracerebral hemorrhage (ICH).
- To determine the optimal FBG range for minimizing ICH risk.
- To analyze FBG as a predictor for ICH in a large community cohort.
Main Methods:
- Prospective cohort study of 96,110 participants from the Kailuan study (China).
- Baseline assessment in 2006, with FBG measured in 2006, 2008, 2010, and 2012.
- Cumulative average FBG used as the primary exposure; ICH cases identified through 2015.
Main Results:
- A total of 755 incident ICH cases were recorded over 817,531 person-years.
- The lowest ICH risk was observed at FBG of 5.3 mmol/L.
- Elevated FBG (≥7.00 mmol/L, diabetes) showed a 1.59-fold increased ICH risk.
- Impaired FBG (6.10-6.99 mmol/L) showed a 1.31-fold increased ICH risk.
- Hypoglycemia (<4.00 mmol/L) showed a 2.04-fold increased ICH risk.
- Normal FBG (4.00-5.59 mmol/L) served as the reference group.
Conclusions:
- Both low (<4.0 mmol/L) and high (≥6.1 mmol/L) fasting blood glucose concentrations are associated with an increased risk of incident ICH.
- Fasting blood glucose levels between 4.00 to 6.09 mmol/L appear to be associated with the lowest risk of ICH.
- These findings highlight the importance of glucose control for preventing intracerebral hemorrhage.
Background And Purpose:
Although diabetes mellitus is an established independent risk factor for ischemic stroke, the association between fasting blood glucose and intracerebral hemorrhage (ICH) is limited and inconsistent. The objective of the current study was to examine the potential impact of long-term fasting blood glucose concentration on subsequent risk of ICH.
Methods:
This prospective study included 96 110 participants of the Kailuan study, living in Kailuan community, Tangshan city, China, who were free of cardiovascular diseases and cancer at baseline (2006). Fasting blood glucose concentration was measured in 2006, 2008, 2010, and 2012. Updated cumulative average fasting blood glucose concentration was used as primary exposure of the current study. Incident ICH from 2006 to 2015 was confirmed by review of medical records.
Results:
During 817 531 person-years of follow-up, we identified 755 incident ICH cases. The nadir risk of ICH was observed at fasting blood glucose concentration of 5.3 mmol/L. The adjusted hazard ratios and their 95% confidence intervals (CIs) of ICH were 1.59 (95% CI, 1.26-2.02) for diabetes mellitus or fasting blood glucose ≥7.00 mmol/L, 1.31 (95% CI, 1.02-1.69) for impaired fasting blood glucose (fasting blood glucose, 6.10-6.99 mmol/L), 0.98 (95% CI, 0.78-1.22) for fasting blood glucose 5.60 to 6.09 mmol/L, and 2.04 (95% CI, 1.23-3.38) for hypoglycemia (fasting blood glucose, <4.00 mmol/L), comparing with normal fasting blood glucose 4.00 to 5.59 mmol/L. The results persisted after excluding individuals who used hypoglycemic, aspirin, antihypertensive agents, or anticoagulants, and those with intracerebral hemorrhagic cases occurred in the first 2 years of follow-up.
Conclusions:
In this large community-based cohort, low (<4.0 mmol/L) and high (≥6.1 mmol/L) fasting blood glucose concentrations were associated with higher risk of incident ICH, relative to fasting blood glucose concentrations of 4.00 to 6.09 mmol/L.
