Diabetes, hyperglycemia, and coronary heart disease
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Asymptomatic hyperglycemia showed no consistent link to coronary heart disease (CHD) mortality. However, very high blood glucose levels, above the 95th percentile, were associated with increased risk for CHD and stroke mortality.
Area of Science:
- Cardiology
- Endocrinology
- Epidemiology
Background:
- Asymptomatic hyperglycemia is a state of elevated blood glucose without diagnosed diabetes.
- The relationship between asymptomatic hyperglycemia and coronary heart disease (CHD) requires further investigation.
- Understanding these links is crucial for cardiovascular disease prevention strategies.
Purpose of the Study:
- To investigate the association between asymptomatic hyperglycemia and coronary heart disease (CHD) mortality.
- To explore the correlation between blood glucose levels and cardiovascular risk factors.
- To determine if hyperglycemia acts as an independent risk factor for CHD.
Main Methods:
- An international collaborative study involving 48,912 men aged 35-64.
- Exclusion of individuals with diagnosed diabetes or treated hypertension.
- Analysis of post-load circulating glucose levels, ECG findings, and mortality data.
Main Results:
- Post-load glucose correlated with age, relative weight, and systolic blood pressure.
- S-T/T findings on ECG were more prevalent in the highest glucose quintile.
- No consistent, strong, or independent association was found between glycemia and CHD mortality overall.
- A threshold effect was observed in the Whitehall Study: CHD mortality doubled above the 95th percentile of glycemia.
- Stroke mortality showed a similar increase at high glycemia levels.
Conclusions:
- While asymptomatic hyperglycemia may not be a consistent independent predictor of CHD mortality across all levels, significantly elevated blood glucose poses a risk.
- High blood glucose levels are associated with other cardiovascular risk factors like obesity and hypertension.
- Threshold effects suggest that very high glucose levels, even without diagnosed diabetes, warrant clinical attention for cardiovascular risk reduction.
Abstract:
An international collaborative group examined the relation between asymptomatic hyperglycemia and coronary heart disease (CHD). After excluding clinically diagnosed diabetes and treated hypertensives, there were 48,912 men aged 35-64 in the study population. Post-load circulating glucose correlated with age, relative weight, and systolic blood pressure. The prevalence on ECG of S-T/T findings, but not of Q/QS items, was higher in the top quintile of glycemia. For CHD mortality there was no consistent, strong, or independent association with glycemia. In the Whitehall Study (the largest), it appeared that there was a threshold effect, CHD mortality being about twice as high above the 95th percentile of glycemia. Stroke mortality was increased to a similar extent.