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(Circulation. 2007;116:151-157.)
© 2007 American Heart Association, Inc.

Epidemiology

Risk of Cardiovascular and All-Cause Mortality in Individuals With Diabetes Mellitus, Impaired Fasting Glucose, and Impaired Glucose Tolerance

The Australian Diabetes, Obesity, and Lifestyle Study (AusDiab)

Elizabeth L.M. Barr, MPH; Paul Z. Zimmet, PhD; Timothy A. Welborn, PhD; Damien Jolley, MSc; Dianna J. Magliano, PhD; David W. Dunstan, PhD; Adrian J. Cameron, MPH; Terry Dwyer, MD; Hugh R. Taylor, MD; Andrew M. Tonkin, MD; Tien Y. Wong, PhD; John McNeil, PhD; Jonathan E. Shaw, MD

From the International Diabetes Institute (E.L.M.B., P.Z.Z., D.J.M., D.W.D., A.J.C., J.E.S.), Caulfield, Victoria, Australia; Department of Medicine (T.A.W.), University of Western Australia, Nedlands, Western Australia; Monash Institute of Health Services Research (D.J.), Clayton, Victoria, Australia; Murdoch Children’s Research Institute (T.D.), Royal Children’s Hospital, Prahran, Victoria, Australia; Centre for Eye Research Australia (H.R.T., T.Y.W.), University of Melbourne, East Melbourne, Victoria, Australia; and Department of Epidemiology and Preventive Medicine (A.M.T., J.M.), Monash University, Prahran, Victoria, Australia.

Correspondence to Elizabeth L.M. Barr, International Diabetes Institute, 250 Kooyong Rd, Caulfield, Victoria, 3162, Australia. E-mail lbarr{at}idi.org.au

Received December 19, 2006; accepted May 7, 2007.

Background— Diabetes mellitus increases the risk of cardiovascular disease (CVD) and all-cause mortality. The relationship between milder elevations of blood glucose and mortality is less clear. This study investigated whether impaired fasting glucose and impaired glucose tolerance, as well as diabetes mellitus, increase the risk of all-cause and CVD mortality.

Methods and Results— In 1999 to 2000, glucose tolerance status was determined in 10 428 participants of the Australian Diabetes, Obesity, and Lifestyle Study (AusDiab). After a median follow-up of 5.2 years, 298 deaths occurred (88 CVD deaths). Compared with those with normal glucose tolerance, the adjusted all-cause mortality hazard ratios (HRs) and 95% confidence intervals (CIs) for known diabetes mellitus and newly diagnosed diabetes mellitus were 2.3 (1.6 to 3.2) and 1.3 (0.9 to 2.0), respectively. The risk of death was also increased in those with impaired fasting glucose (HR 1.6, 95% CI 1.0 to 2.4) and impaired glucose tolerance (HR 1.5, 95% CI 1.1 to 2.0). Sixty-five percent of all those who died of CVD had known diabetes mellitus, newly diagnosed diabetes mellitus, impaired fasting glucose, or impaired glucose tolerance at baseline. Known diabetes mellitus (HR 2.6, 95% CI 1.4 to 4.7) and impaired fasting glucose (HR 2.5, 95% CI 1.2 to 5.1) were independent predictors for CVD mortality after adjustment for age, sex, and other traditional CVD risk factors, but impaired glucose tolerance was not (HR 1.2, 95% CI 0.7 to 2.2).

Conclusions— This study emphasizes the strong association between abnormal glucose metabolism and mortality, and it suggests that this condition contributes to a large number of CVD deaths in the general population. CVD prevention may be warranted in people with all categories of abnormal glucose metabolism.

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