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on June 18, 2007

Circulation. 2007
Published online before print June 18, 2007, doi: 10.1161/CIRCULATIONAHA.106.685628
A more recent version of this article appeared on July 10, 2007
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 Circulation: July 10, 2007, Volume 116, Number 2
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Submitted on December 19, 2006
Accepted on May 7, 2007

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, and 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.

* To whom correspondence should be addressed. E-mail: lbarr{at}idi.org.au.

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.
Key words: epidemiology • diabetes mellitus • mortality • risk factors • cardiovascular diseases • risk factors




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