Published online before print February 2, 2009, doi: 10.1161/CIRCULATIONAHA.108.776989
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(Circulation. 2009;119:812-819.)
© 2009 American Heart Association, Inc.
Epidemiology |
Fasting Blood Glucose and the Risk of Stroke and Myocardial Infarction
From the Department of Epidemiology, the Graduate School of Public Health, and Institute of Health and Environment, Seoul National University, Seoul, South Korea (J.S.); Department of Epidemiology and Cancer Prevention, National Cancer Center, Goyang, Gyeonggi-do, South Korea (J.S.); Department of Family Medicine, Samsung Medical Center, and Center for Clinical Research, Samsung Biomedical Research Institute, SungKyunKwan University School of Medicine, Seoul, South Korea (Y.S.);. Noncommunicable Disease Epidemiology Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK (S.E.); and MRC Centre for Causal Analyses in Translational Epidemiology, University of Bristol, Bristol, UK (D.A.L.).
Correspondence to Dr Yun-Mi Song, Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwondong, Gangnamgu, Seoul, South Korea 135-710. E-mail yunmisong{at}skku.edu
Received March 9, 2008; accepted November 6, 2008.
Background— Although diabetes is a well-known risk factor of atherosclerotic cardiovascular diseases, the cardiovascular disease risk of glycemia below the current diabetic threshold remains uncertain.
Methods and Results— A total of 652 901 Korean men aged 30 to 64 years from the Korean National Health Insurance System were categorized into 8 groups by fasting blood glucose (FBG) level at baseline and were followed up for cardiovascular diseases occurrence during 1992–2001. Over the follow-up period of 8.8 years, 10 954 stroke and 3766 myocardial infarction events occurred. In age-adjusted analyses, there was evidence of linear associations between FBG and myocardial infarction, ischemic stroke, and intracerebral hemorrhagic stroke. However, with additional adjustment for socioeconomic position, behaviors, and other cardiovascular disease risk factors, the associations with myocardial infarction and intracerebral hemorrhagic stroke were markedly attenuated with increased risk only at the highest FBG levels (
7.5 mmol/L). With full adjustment, the association with ischemic stroke persisted; a linear increase in the risk of ischemic stroke was observed from FBG level of 5.6 mmol/L. When the analyses were repeated with those persons who had been diagnosed with diabetes removed, there was no evidence of associations of FBG with intracerebral hemorrhagic stroke, but the association with ischemic stroke persisted.
Conclusions— In this Korean male population, the association with high FBG differed between ischemic stroke, intracerebral hemorrhagic stroke, and myocardial infarction. The linear increase in the risk of ischemic stroke, independently of other cardiovascular risk factors, was observed at a level below the current FBG criteria for impaired fasting glucose (5.6 mmol/L). However, for other cardiovascular diseases, the current cutoff for diagnosing diabetes appropriately identified Korean men at risk.
CLINICAL PERSPECTIVE
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Clinical Summaries
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