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(Circulation. 2000;101:2047.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Low Fasting Plasma Glucose Level as a Predictor of Cardiovascular Disease and All-Cause Mortality

Ming Wei, MD; Larry W. Gibbons, MD; Tedd L. Mitchell, MD; James B. Kampert, PhD; Michael P. Stern, MD; Steven N. Blair, PED

From the Cooper Institute (M.W., J.B.K., S.N.B.) and the Cooper Clinic (L.W.G., T.L.M.), Dallas, and the Department of Medicine (M.P.S.), University of Texas Health Science Center, San Antonio, Tex.

Background—Although medical textbooks usually classify fasting plasma glucose <70 or 80 mg/dL (<3.89 or 4.44 mmol/L) as abnormal, the prognosis for patients with low fasting plasma glucose is unclear.

Methods and Results—We conducted prospective cohort studies among 40 069 men and women to investigate the association between fasting plasma glucose levels and cardiovascular disease and all-cause mortality. We documented a U-shaped relation between fasting plasma glucose and mortality. In addition to diabetes and impaired fasting glucose levels, low fasting plasma glucose levels were also associated with high mortality. After multivariate adjustment for age, sex, study population, ethnicity, current smoking status, high blood pressure, total cholesterol, body mass index, triglycerides, history of cardiovascular disease and cancer, and a family history of cardiovascular disease, patients with fasting plasma glucose <70 mg/dL (<3.89 mmol/L) had a 3.3-fold increased risk of cardiovascular disease mortality, and patients with fasting plasma glucose 70 to 79 mg/dL (3.89 to 4.43 mmol/L) had a 2.4-fold increased risk compared with the risk in patients with fasting plasma glucose 80 to 109 mg/dL (4.44 to 6.05 mmol/L) (tests for trend P<0.0001). Participants with low fasting plasma glucose levels also had increased risk of all-cause mortality (test for trend P<0.0001).

Conclusions—Participants with low fasting plasma glucose levels had a high risk of cardiovascular disease and all-cause mortality.

Key Words: glucose • cardiovascular diseases • mortality

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