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Long-term CVD risk higher with rising fasting glucose levels in middle age
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Middle-aged adults who experience an increase in fasting glucose level into the range for diabetes have an elevated 30-year risk for coronary heart disease and stroke compared with their peers with normal blood glucose levels, according to findings published in Diabetes Care.
Researchers also observed an increased long-term CVD risk for middle-aged men with fasting glucose in the prediabetes range.
“It is well-known that individuals with prediabetes levels of blood sugar during middle age are at high risk for developing diabetes over the next 5 years,” Michael P. Bancks, PhD, an assistant professor in the department of epidemiology and prevention at the Wake Forest School of Medicine in Winston-Salem, North Carolina, told Endocrine Today. “Some research has shown that people with prediabetes have higher risk for developing cardiovascular disease over the next 5 to 10 years than if their blood sugar was normal or below the threshold for prediabetes.”
Using data pooled from seven observational cohorts that included both white and black adults, Bancks and colleagues estimated the long-term risk for CVD based on fasting glucose levels both below and above the threshold for diabetes ( 7 mmol/L). Combined, the seven cohorts followed participants from 1960 to 2015. A total of 19,630 participants (56.1% women; 31.6% black) at an index age of 55 years were included. The researchers created five stratifications for fasting glucose levels: less than 5 mmol/L, between 5 mmol/L and 5.5 mmol/L, between 5.6 mmol/L and 6.2 mmol/L, between 6.3 mmol/L and 6.9 mmol/L (prediabetes) and more than 7 mmol/L (diabetes). CVD was defined as CHD, myocardial infarction and fatal and nonfatal stroke.
In the pooled data, there were 2,217 reported CVD events. Risk for CVD from age 55 to 85 years followed a largely parallel upward trajectory with increasing fasting glucose levels in both women and men. Specifically, the risk for CVD over 30 years for women rose from 15.3% (95% CI, 12.3-18.3) at a fasting glucose level of less than 5 mmol/L to 38.6% (95% CI, 33.4-43.8) at a fasting glucose level of at least 7 mmol/L. In men, the risk for CVD rose from 21.5% (95% CI, 19-24.1) at a fasting glucose level between 5 mmol/L and 5.5 mmol/L to 47.7% (95% CI, 42.8-52.7) at a fasting glucose level of at least 7 mmol/L. Despite these findings, the researchers noted that there was no statistically significant difference in risk for women with fasting glucose levels between 5 mmol/L and 6.9 mmol/L compared with the reference group (< 5 mmol/L). Conversely, there was a significantly higher risk for men with fasting glucose in the prediabetes range (6.3-6.9 mmol/L) compared with the reference group (RR = 1.61; 95% CI, 1.32-1.97).
When stratifying based on race, the researchers found that 20-year risk estimates for CVD for white adults with diabetes (31.6%; 95% CI, 10.1-53.1 in women; 32.3%; 95% CI, 18.6-46.1 in men) were higher than for black adults with diabetes (19.5%; 95% CI, 9.6-29.5 in women; 25.5%; 95% CI, 12.4-38.6 in men).
Men with diabetes had a higher 30-year risk for CHD (35.5%; 95% CI, 30.8-40.2) compared with women with diabetes (25.5%; 95% CI, 21-29.9), whereas women with diabetes had a higher 30-year risk for stroke (21.1%; 95% CI, 17-25.5) compared with men with diabetes (17.6%; 95% CI, 14.1-21.1).
The researchers also examined a subset of participants (n = 16,070; 57.2% women) who had multiple fasting glucose measurements to determine how a 4-year change in glucose category affected CVD risk. Participants who transitioned from normal fasting glucose to diabetes levels (25.5%; 95% CI, 0-59 in women; 42.8%; 95% CI, 7.2-78.3 in men) and those who transitioned from impaired fasting glucose to diabetes levels (35.7%; 95% CI, 11.2-60.2 in women; 38%; 95% CI, 24.6-51.4) had higher risks than participants who remained under the diabetes threshold at all fasting glucose measurements.
“This research shows the importance of preventing or delaying the development of diabetes in order to prevent the development of cardiovascular disease,” Bancks said. “Prior research on this topic among U.S. populations is based on white populations in [the] Boston area. Our study included a large number of African-Americans and people from geographically diverse areas of the U.S. [so] our findings can be generalized to a much broader U.S. audience than the prior work.” – by Phil Neuffer
Disclosures: The authors report no relevant financial disclosures.
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