Abstract 3680: Glucose Levels Predict Incident Cardiovascular Events In A Large International Multiethnic Cohort
Background: There is emerging evidence that fasting plasma glucose (FPG) levels are associated with the development of incident cardiovascular (CV) events. In this international prospective cohort study we assessed the relationship between FPG, CV events and death.
Methods: There were 18,990 participants screened for entry into the DREAM clinical trial from 21 different countries. All participants had clinical and biochemical information collected at baseline including an oral glucose tolerance test (OGTT), and were prospectively followed over a median of 3.3 years for incident CV events including coronary artery disease (CAD), stroke, congestive heart failure (CHF) requiring hospitalization, and death. All FPG models were adjusted for age, sex, smoking, prior MI, waist to hip ratio (WHR), hypertension at baseline, use of aspirin, use of a statin medication, mean systolic and diastolic BP at baseline.
Results: The mean age of participants was 51 years, 60% were women, 62% were non-European origin, the mean BMI was 29.8 kg/m2 and WHR was 0.89. After OGTT screening, 9,614 subjects were classified as normoglycemic, 6,798 had impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), and 2,578 subjects had diabetes. 422 individuals suffered incident CAD (n=220), stroke (n=52), CHF hospitalization (n=19) or death (n=131). The annualized CV or death event rate was 0.72/100 person-years in the overall cohort, 0.49/100 person-years in normoglycemics, 0.94/100 person-years among subjects with IFG or IGT, and 0.97/100 person-years among those with diabetes. Among all subjects, a 1 mmol/L increase in FPG was associated with a 1.12 (95% CI: 1.04–1.18) increase in the risk of CV events or death. When stratified by diabetic status, a 1 mmol/L increase in FPG was associated with a 1.24 (95% CI: 1.06–1.46) fold increase in CV events or death among subjects without diabetes compared to 1.09 (95% CI: 0.98–1.20) among subjects with diabetes.
Conclusions: In this large multiethnic cohort, increased FPG is a risk factor for CV events and death. These data suggest that glucose shares a continuous relationship with CV events and death, and clinical trials which lower glucose or modify other known CV risk factors in non-diabetic subjects with elevated FPG are warranted.