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Does non-diabetic hyperglycemia predict future IHD? Evidence from the Caerphilly and Speedwell studies
J W Yarnell1, J E Pickering, P C Elwood
1MRC Epidemiology Unit, Llandough Hospital, Penarth, South Glamorgan, U.K.
Insights
Men with high fasting plasma glucose levels, especially those at 6.8 mmol/l or higher, face increased risk of ischemic heart disease (IHD). This finding suggests a potential pre-diabetic state requiring intervention.
Area of Science:
- Cardiology
- Endocrinology
- Epidemiology
Background:
- Ischemic heart disease (IHD) is a significant health concern.
- Fasting plasma glucose levels are a key indicator for diabetes and metabolic health.
- Understanding the relationship between glucose levels and IHD risk is crucial for preventative strategies.
Purpose of the Study:
- To investigate the association between initial fasting plasma glucose levels and the risk of subsequent ischemic heart disease (IHD) in middle-aged men.
- To determine if elevated glucose levels, even below the diabetic threshold, are associated with increased IHD risk.
- To explore the potential for identifying pre-diabetic states through plasma glucose measurements.
Main Methods:
- Prospective cohort study (Caerphilly Collaborative Study) involving 4860 middle-aged men.
- Measurement of fasting venous plasma glucose levels in diabetic and non-diabetic participants.
- Follow-up assessment for new IHD events and overall mortality, with statistical adjustment for confounding factors (BMI, triglycerides, smoking, pre-existing IHD).
Main Results:
- Diabetic men experienced twice as many new IHD events and a 4-fold increase in overall mortality compared to non-diabetics.
- Among non-diabetics, elevated IHD events were observed in those with fasting plasma glucose levels of 6.8 mmol/l (122 mg/dl) or higher.
- This association remained statistically significant after adjusting for key confounding factors.
Conclusions:
- A fasting plasma glucose level of 6.8 mmol/l or higher is associated with a significantly increased risk of IHD, even in non-diabetic individuals.
- These elevated levels may indicate a pre-diabetic state.
- Non-pharmacological interventions could potentially prevent progression to diabetes and reduce cardiovascular risk, warranting further experimental study.
Abstract:
We have examined the risk of subsequent ischemic heart disease (IHD) in men according to their initial fasting plasma glucose level in a prospective cohort study (Caerphilly Collaborative Study) of 4860 middle aged men from South Wales and Bristol, U.K. Ninety-four men reported themselves to be diabetic at initial screening and fasting venous plasma glucose levels were determined in these men and in a further 4519 non-diabetic men. At follow-up new IHD events occurred twice as commonly in diabetics compared to non-diabetics and overall mortality was increased 4-fold. Among non-diabetics however, increased IHD events only occurred in men with fasting values at the upper end of the distribution of baseline plasma glucose values [at 6.8 mmol/l (122 mg/dl) or more]. This association was reduced, but remained statistically significant, after adjusting for factors associated with plasma glucose levels; body mass index, plasma triglyceride, smoking habit and pre-existing IHD. In conclusion there is no evidence of a consistent, graded increase in risk of IHD by initial fasting plasma glucose level although the risk is significantly increased in men with baseline plasma values at 6.8 mmol/l (122 mg/dl) or more, and also in diabetics. This study suggests that such levels probably represent a pre-diabetic state in many individuals. Appropriate non-pharmacological intervention may be useful in halting the progression to the diabetic state, although this should be tested in experimental studies.