Cited by 175Diabetes, Cardiovascular Risks, and LipoproteinsDiet, Metabolism, and DiseaseDiabetes Management and Research

Markers of dysglycaemia and risk of coronary heart disease in people without diabetes: Reykjavik prospective study and systematic review

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Sarwar, Nadeem, Aspelund, Thor, Eiriksdottir, Gudny, Gobin, Reeta, Seshasai, Sreenivasa Rao Kondapally, Forouhi, Nita G., Sigurdsson, Gunnar, Danesh, John +1 more·2010·PLoS Medicine

Abstract

BACKGROUND: Associations between circulating markers of dysglycaemia and coronary heart disease (CHD) risk in people without diabetes have not been reliably characterised. We report new data from a prospective study and a systematic review to help quantify these associations. METHODS AND FINDINGS: Fasting and post-load glucose levels were measured in 18,569 participants in the population-based Reykjavik study, yielding 4,664 incident CHD outcomes during 23.5 y of mean follow-up. In people with no known history of diabetes at the baseline survey, the hazard ratio (HR) for CHD, adjusted for several conventional risk factors, was 2.37 (95% CI 1.79-3.14) in individuals with fasting glucose > or = 7.0 mmol/l compared to those < 7 mmol/l. At fasting glucose values below 7 mmol/l, adjusted HRs were 0.95 (0.89-1.01) per 1 mmol/l higher fasting glucose and 1.03 (1.01-1.05) per 1 mmol/l higher post-load glucose. HRs for CHD risk were generally modest and nonsignificant across tenths of glucose values below 7 mmol/l. We did a meta-analysis of 26 additional relevant prospective studies identified in a systematic review of Western cohort studies that recorded fasting glucose, post-load glucose, or glycated haemoglobin (HbA(1c)) levels. In this combined analysis, in which participants with a self-reported history of diabetes and/or fasting blood glucose > or = 7 mmol/l at baseline were excluded, relative risks for CHD, adjusted for several conventional risk factors, were: 1.06 (1.00-1.12) per 1 mmol/l higher fasting glucose (23 cohorts, 10,808 cases, 255,171 participants); 1.05 (1.03-1.07) per 1 mmol/l higher post-load glucose (15 cohorts, 12,652 cases, 102,382 participants); and 1.20 (1.10-1.31) per 1% higher HbA(1c) (9 cohorts, 1639 cases, 49,099 participants). CONCLUSIONS: In the Reykjavik Study and a meta-analysis of other Western prospective studies, fasting and post-load glucose levels were modestly associated with CHD risk in people without diabetes. The meta-analysis suggested a somewhat stronger association between HbA(1c) levels and CHD risk.

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  • Average glucose levels indexed by HbA1c predict incident coronary disease at least as well as fasting and postload glucose, though there are comparatively few prospective studies of HbA1c.

    “Whether it is the basal or the challenged blood glucose level that is more important for atherogenesis, average glucose levels, indexed by HbA1c concentration, predict incident coronary disease at least as well as fasting and postload glucose, though there are comparatively few prospective studies of HbA1c.89”

    From Prediabetes: a high-risk state for diabetes development (2012) · cites this paper as [89]

  • Recent individual-level evidence from prospective studies suggests that fasting hyperglycaemia, postload glucose, and A1c are all robust predictors of vascular mortality, and multivariable adjusted analyses indicate these associations are independent of vascular risk factors such as obesity, blood pressure, triglyceride and lipoproteins.

    “A recent individual-level evidence from prospective studies suggests that fasting hyperglycaemia (figure 3), postload glucose, and A1c are all robust predictors of vascular mortality86,88,89 and, according to multivariable adjusted analyses, these associations are independent of vascular risk factors, such as obesity, blood pressure, triglyceride and lipoproteins.84,85,87”

    From Prediabetes: a high-risk state for diabetes development (2012) · cites this paper as [89]

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Authors
Sarwar, N., Aspelund, T., Eiriksdottir, G., Gobin, R., Seshasai, S. R. K., Forouhi, N. G., Sigurdsson, G., Danesh, J., & Gudnason, V.
Affiliations
  • University of Cambridge (GB)
  • University of Iceland (IS)
  • MRC Epidemiology Unit (GB)
Corresponding author
Sarwar, Nadeem
Venue
PLoS Medicine
Published
2010-05-25
Volume
7
Issue
5
Pages
e1000278
ISSN
  • 1549-1277 (ISSN-L)
  • 1549-1676
OpenAlex
W1992852296
Cited by
175
References
54
Citations by year
2026: 1 · 2025: 7 · 2024: 2 · 2023: 11 · 2022: 9 · 2021: 9 · 2020: 9 · 2019: 8 · 2018: 12 · 2017: 10 · 2016: 12 · 2015: 15 · 2014: 16 · 2013: 18 · 2012: 15
FWCI
2.46
Type
journal article
Language
en
Open access
Locations
  • PLoS Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • St George's Online Research Archive (St George's University of London) (acceptedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
Funders
  • Pfizer
  • GlaxoSmithKline
  • Wellcome Trust
  • British Heart Foundation (RG/08/014/24067)
  • Bupa Foundation
  • European Commission
  • Cambridge Trust
  • Evelyn Trust
  • Gates Cambridge Trust
  • Medical Research Council
  • National Heart, Lung, and Blood Institute
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords
dysglycemia, coronary artery disease, fasting blood glucose, post-load glucose, HbA1c, non-diabetic individuals, cardiovascular risk, hyperglycemia, prediabetes, Reykjavik Study, HbA1c thresholds
MeSH terms
Adult, Blood Glucose, Coronary Disease, Diabetes Mellitus, Fasting, Female, Glycated Hemoglobin, Humans, Hyperglycemia, Male, Middle Aged, Prospective Studies, Reference Values, Risk Factors, Biomarkers

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