Blood glucose and risk of cardiovascular disease in the Asia Pacific region.
Open accessAbstract
OBJECTIVE—To assess the shape and strength of the association between usual blood glucose and cardiovascular disease (CVD) in Asian and Australasian cohorts and to determine the impact of adjusting for other determinants of CVD risk and excluding people with diabetes. RESEARCH DESIGN AND METHODS—Relative risk estimates and 95% CIs were calculated from Cox models, stratified by sex and cohort, and adjusted for age at risk on individual participant data from 17 cohort studies. Repeat measurements of blood glucose were used to adjust for regression dilution bias. RESULTS—Fasting blood glucose data were available for 237,468 participants, and during ∼1.2 million person-years of follow-up, there were 1,661 stroke and 816 ischemic heart disease (IHD) events. Data were also available on 27,996 participants with nonfasting glucose measurements. Continuous positive associations were demonstrated between usual fasting glucose and the risks of CVD down to at least 4.9 mmol/l. Overall, each 1 mmol/l lower usual fasting glucose was associated with a 21% (95% CI 18–24%) lower risk of total stroke and a 23% (19–27%) lower risk of total IHD. The associations were similar in men and women, across age-groups, and in Asian compared with Australasian (Australia and New Zealand) populations. Adjusting for potential confounders or removing those with diabetes as baseline did not substantially affect the associations. Associations for nonfasting glucose were weaker than those with fasting glucose. CONCLUSIONS—Fasting blood glucose is an important determinant of CVD burden, with considerable potential benefit of usual blood glucose lowering down to levels of at least 4.9 mmol/l.
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Relative risks for blood pressure, LDL cholesterol, and fasting plasma glucose were adjusted for regression dilution bias using studies with repeated exposure measurement; for blood pressure and LDL cholesterol, the adjusted magnitude is supported by effect sizes from randomized studies.
“We used RRs for blood pressure, LDL cholesterol, and FPG that were adjusted for regression dilution bias using studies that had repeated exposure measurement [7],[11], [12]; for blood pressure and LDL cholesterol, the adjusted magnitude is supported by effect sizes from randomized studies [13],[14].”
From The Preventable Causes of Death in the United States: Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors (2009) · cites this paper as [7]
Current evidence suggests that when measured comparably the proportional effects of the risk factors considered in this analysis are similar across populations, such as Western and Asian populations.
“The current evidence suggests that when measured comparably the proportional effects of the risk factors considered in this analysis are similar across populations, e.g., Western and Asian populations [7],[20],[21].”
From The Preventable Causes of Death in the United States: Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors (2009) · cites this paper as [7]
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Cites
Regression Models and Life-Tables
Cox, D. R. (1972) · Journal of the Royal Statistical Society Series B: Statistical Methodology · doi:10.1111/j.2517-6161.1972.tb00899.x · Cited by 39,793 · see citing works
Stearne, M. R., Palmer, S. L., Hammersley, M. S., Franklin, S. L., Spivey, R. S., Lévy, J., Tidy, C. R., Bell, N. J., Steemson, J., Barrow, B. A., et al. (1998) · UCL Discovery (University College London) · Cited by 4,803 · see citing works
MACMAHON, S. (1990) · The Lancet · doi:10.1016/0140-6736(90)90878-9 · Cited by 4,253 · cited 3× · see citing works
“(21), have been used in previous analyses of APCSC data, and each yielded very similar regression dilution ratios (11).”
BackgroundMethodInfluentialOhkubo, Y., Kishikawa, H., Araki, E., Miyata, T., Isami, S., Motoyoshi, S., Kojima, Y., Furuyoshi, N., & Shichiri, M. (1995) · Diabetes Research and Clinical Practice · doi:10.1016/0168-8227(95)01064-k · Cited by 3,079 · see citing works
Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus
The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus (2003) · Diabetes Care · doi:10.2337/diacare.26.2007.s5 · Cited by 2,689 · see citing works
Stearne, M. R., Palmer, S. L., Hammersley, M. S., Franklin, S. L., Spivey, R. S., Lévy, J., Tidy, C. R., Bell, N. J., Steemson, J., Barrow, B., et al. (1998) · BMJ · doi:10.1136/bmj.317.7160.713 · Cited by 1,784 · see citing works
Coutinho, M., Gerstein, H. C., Wang, Y., & Yusuf, S. (1999) · Diabetes Care · doi:10.2337/diacare.22.2.233 · Cited by 1,685 · see citing works
Stearne, M. R., Palmer, S. L., Hammersley, M. S., Franklin, S. L., Spivey, R. S., Lévy, J., Tidy, C. R., Bell, N. J., Steemson, J., Barrow, B. A., et al. (1998) · UCL Discovery (University College London) · Cited by 1,406 · see citing works
Glucose Tolerance and Cardiovascular Mortality: Comparison of Fasting and 2-Hour Diagnostic Criteria
(2001) · Archives of Internal Medicine · doi:10.1001/archinte.161.3.397 · Cited by 1,371 · see citing works
Modelling Survival Data in Medical Research
Collett, D. (1994) · Springer eBooks · doi:10.1007/978-1-4899-3115-3 · Cited by 1,064 · see citing works
Prospective Studies Collaboration, & Kromhout, D. (1995) · The Lancet · doi:10.1016/s0140-6736(95)92836-7 · Cited by 851 · see citing works
Neaton, J. D. (1992) · Archives of Internal Medicine · doi:10.1001/archinte.1992.00400130082009 · Cited by 784 · see citing works
Blood pressure and cardiovascular disease in the Asia Pacific region
Asia Pacific Cohort Studies Collaboration (2003) · Journal of Hypertension · doi:10.1097/00004872-200304000-00013 · Cited by 643 · see citing works
Self-citationBalkau, B., Shipley, M. J., Jarrett, R. J., Pyörälà, K., Pyörälä, M., Forhan, A., & Eschwège, É. (1998) · Diabetes Care · doi:10.2337/diacare.21.3.360 · Cited by 597 · see citing works
The DECODE Study Group, & on behalf of the European Diabetes Epidemiology Group (2003) · Diabetes Care · doi:10.2337/diacare.26.3.688 · Cited by 516 · see citing works
Implications of the United Kingdom Prospective Diabetes Study
American Diabetes Association (2003) · Diabetes Care · doi:10.2337/diacare.26.2007.s28 · Cited by 446 · see citing works
Easton, D. F., Peto, J., & Babiker, A. G. (1991) · Statistics in Medicine · doi:10.1002/sim.4780100703 · Cited by 434 · see citing works
Cholesterol, coronary heart disease, and stroke in the Asia Pacific region.
Asia Pacific Cohort Studies Collaboration (2003) · International Journal of Epidemiology · doi:10.1093/ije/dyg106 · Cited by 382 · see citing works
Self-citationAsia Pacific Cohort Studies Collaboration (2004) · International Journal of Epidemiology · doi:10.1093/ije/dyh163 · Cited by 375 · see citing works
Self-citationthe DECODA Study Group, & Nakagami, T. (2004) · Diabetologia · doi:10.1007/s00125-004-1334-6 · Cited by 331 · see citing works
Tunstall-Pedoe, H., Woodward, M., Tavendale, R., Brook, R. A., & McCluskey, M. K. (1997) · BMJ · doi:10.1136/bmj.315.7110.722 · Cited by 317 · see citing works
Asia Pacific Cohort Studies Collaboration (2003) · Diabetes Care · doi:10.2337/diacare.26.2.360 · Cited by 297 · see citing works
Self-citationRisk factor thresholds: their existence under scrutiny
Law, M. R., & Wald, N. J. (2002) · BMJ · doi:10.1136/bmj.324.7353.1570 · Cited by 261 · see citing works
Abraira, C. (1997) · Archives of Internal Medicine · doi:10.1001/archinte.157.2.181 · Cited by 253 · see citing works
Diabetes Mellitus and Macrovascular Complications: An epidemiological perspective
Donahue, R. P., & Orchard, T. J. (1992) · Diabetes Care · doi:10.2337/diacare.15.9.1141 · Cited by 230 · see citing works
Is fasting glucose sufficient to define diabetes? Epidemiological data from 20 European studies
The DECODE-study group on behalf of the (1999) · Diabetologia · doi:10.1007/s001250051211 · Cited by 227 · see citing works
Comparison of the fasting and the 2-h glucose criteria for diabetes in different Asian cohorts
Qiao, Q., Nakagami, T., Tuomilehto, J., Borch‐Johnsen, K., Balkau, B., Iwamoto, Y., & Tajima, N. (2000) · Diabetologia · doi:10.1007/s001250051557 · Cited by 206 · see citing works
Bjørnholt, J. V., Erikssen, G., Aaser, E., Sandvik, L., NITTER‐HAUGE, S., Jervell, J., Erikssen, J., & Thaulow, E. (1999) · Diabetes Care · doi:10.2337/diacare.22.1.45 · Cited by 201 · see citing works
Qiao, Q. (2002) · European Heart Journal · doi:10.1053/euhj.2001.3113 · Cited by 180 · see citing works
Is there a glycemic threshold for mortality risk?
Balkau, B., Bertrais, S., Ducimetière, P., & Eschwège, É. (1999) · Diabetes Care · doi:10.2337/diacare.22.5.696 · Cited by 160 · see citing works
Dysglycaemia and risk of cardiovascular disease
Gerstein, H. C., & Yusuf, S. (1996) · The Lancet · doi:10.1016/s0140-6736(96)91420-8 · Cited by 138 · see citing works
Khatun, M., Ahlgren, C., & Hammarström, A. (2004) · International Journal of Epidemiology · Cited by 99 · see citing works
Carroll, R. J., & Stefanski, L. A. (1994) · Statistics in Medicine · doi:10.1002/sim.4780131208 · Cited by 90 · see citing works
Does Hyperglycemia Really Cause Coronary Heart Disease?
Barrett-Connor, E. (1997) · Diabetes Care · doi:10.2337/diacare.20.10.1620 · Cited by 82 · see citing works
Impaired glucose tolerance. Why is it not a disease?
Perry, R., & Baron, A. D. (1999) · Diabetes Care · doi:10.2337/diacare.22.6.883 · Cited by 64 · see citing works
Role of risk factors for major coronary heart disease events with increasing length of follow up
Wannamethee, S. G., Shaper, A. G., Whincup, P. H., & Walker, M. (1999) · Heart · doi:10.1136/hrt.81.4.374 · Cited by 55 · see citing works
Is There a Glycemic Threshold for Mortality Risk?
Harris, M. I., & Eastman, R. C. (1998) · Diabetes Care · doi:10.2337/diacare.21.3.331 · Cited by 42 · see citing works
Fasting Versus Postload Glucose Levels
Gerstein, H. C. (2001) · Diabetes Care · doi:10.2337/diacare.24.11.1855 · Cited by 32 · see citing works
Bonora, E., Kiechl, S. J., Willeit, J., Oberhollenzer, F., Egger, G., Bonadonna, R. C., & Muggeo, M. (1999) · Diabetes Care · doi:10.2337/diacare.22.8.1339 · Cited by 30 · see citing works
Asymptomatic hyperglycaemia and major ischaemic heart disease events in Britain.
Perry, I. J., Wannamethee, S. G., Whincup, P. H., & Shaper, A. G. (1994) · Journal of Epidemiology & Community Health · doi:10.1136/jech.48.6.538 · Cited by 27 · see citing works
Glycemia and Cardiovascular Risk
Stern, M. P. (1997) · Diabetes Care · doi:10.2337/diacare.20.10.1501 · Cited by 23 · see citing works
Quality of care in diabetes: understanding the guidelines.
Bouldin, M., Low, A., Blackston, J. W., Duddleston, D. N., Holman, H. E., Hicks, G. S., & Brown, C. A. (2002) · American Journal of the Medical Sciences · doi:10.1097/00000441-200210000-00006 · Cited by 14 · see citing works
Hyperglycaemia as a risk factor for coronary heart disease.
Fh, E. (1985) · PubMed · Cited by 10 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- [17]17. Rose G: The Strategy of Preventive Medicine. Oxford, U.K., Oxford University Press, 1992
Cited by
Sorted by citations
Lim, S. S., Vos, T., Flaxman, A. D., Danaei, G., Shibuya, K., Adair-Rohani, H., AlMazroa, M. A., Amann, M., Anderson, H. R., Andrews, K. G., et al. (2012) · The Lancet · doi:10.1016/s0140-6736(12)61766-8 · Cited by 11,805 · see citing works
The Emerging Risk Factors Collaboration (2010) · The Lancet · doi:10.1016/s0140-6736(10)60484-9 · Cited by 5,125 · see citing works
Danaei, G., Ding, E. L., Mozaffarian, D., Taylor, B., Rehm, J., Murray, C. J. L., & Ezzati, M. (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000058 · Cited by 2,860 · see citing works
The Science of Stroke: Mechanisms in Search of Treatments
Moskowitz, M. A., Lo, E. H., & Iadecola, C. (2010) · Neuron · doi:10.1016/j.neuron.2010.07.002 · Cited by 1,930 · see citing works
Intensive glucose control and macrovascular outcomes in type 2 diabetes
Turnbull, F. M., Abraira, C., Anderson, R. J., Byington, R. P., Chalmers, J. P., Duckworth, W. C., Evans, G. W., Gerstein, H. C., Holman, R. R., Moritz, T. E., et al. (2009) · Diabetologia · doi:10.1007/s00125-009-1470-0 · Cited by 1,189 · see citing works
Singh, G. M., Danaei, G., Farzadfar, F., Stevens, G. A., Woodward, M., Wormser, D., Kaptoge, S., Whitlock, G., Qiao, Q., Lewington, S., et al. (2013) · PLoS ONE · doi:10.1371/journal.pone.0065174 · Cited by 772 · see citing works
Type 2 Diabetes and the Risk of Parkinson's Disease
Hu, G., Jousilahti, P., Bidel, S., Antikainen, R., & Tuomilehto, J. (2007) · Diabetes Care · doi:10.2337/dc06-2011 · Cited by 466 · see citing works
Standards of care for type 2 diabetes in China
Weng, J., Ji, L., Jia, W., Lu, J., Zhou, Z., Zou, D., Zhu, D., Chen, L., Chen, L., Guo, L., et al. (2016) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.2827 · Cited by 315 · see citing works
Schwingshackl, L., Chaimani, A., Hoffmann, G., Schwedhelm, C., & Boeing, H. (2018) · European Journal of Epidemiology · doi:10.1007/s10654-017-0352-x · Cited by 273 · see citing works
Gerstein, H. C. (2008) · Archives of Internal Medicine · doi:10.1001/archinte.168.15.1699 · Cited by 217 · see citing works
On behalf of, E. D. E. G., Forouhi, N. G., Balkau, B., Borch-Johnsen, K., Dekker, J., Glumer, C., Qiao, Q., Spijkerman, A., Stolk, R., Tabac, A., et al. (2006) · Diabetologia · doi:10.1007/s00125-006-0189-4 · Cited by 140 · see citing works
Micha, R., Kalantarian, S., Wirojratana, P., Byers, T., Danaei, G., Elmadfa, I., Ding, E., Giovannucci, E., Powles, J., Smith-Warner, S., et al. (2012) · European Journal of Clinical Nutrition · doi:10.1038/ejcn.2011.147 · Cited by 123 · see citing works
Farzadfar, F., Danaei, G., Namdaritabar, H., Rajaratnam, J. K., Marcus, J. R., Khosravi, A., Alikhani, S., Murray, C. J., & Ezzati, M. (2011) · Population Health Metrics · doi:10.1186/1478-7954-9-55 · Cited by 12 · see citing works
Kadowaki, S., Okamura, T., Hozawa, A., Kadowaki, T., Kadota, A., Murakami, Y., Nakamura, K., Saitoh, S., Nakamura, Y., Hayakawa, T., et al. (2008) · Diabetologia · doi:10.1007/s00125-007-0915-6 · Cited by 69 · see citing works
Variation of fasting plasma glucose: A predictor of mortality in patients with type 2 diabetes
Lin, C.-C., Li, C.-I., Yang, S.-Y., Liu, C.-S., Chen, C.-C., Fuh, M. M.-T., Chen, W., & Li, T.-C. (2012) · The American Journal of Medicine · doi:10.1016/j.amjmed.2011.07.027 · Cited by 59 · see citing works
Benn, M., Emanuelsson, F., Tybjærg-Hansen, A., & Nordestgaard, B. G. (2021) · Diabetologia · doi:10.1007/s00125-021-05436-0 · Cited by 41 · see citing works
- Authors
- Asia Pacific Cohort Studies Collaboration
- Affiliations
- University of Auckland (NZ)
- Corresponding author
- Asia Pacific Cohort Studies Collaboration
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2004-12-01
- Volume
- 27
- Issue
- 12
- Pages
- 2836-2842
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W1491165075
- Cited by
- 302
- References
- 48
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 9 · 2023: 8 · 2022: 13 · 2021: 21 · 2020: 16 · 2019: 9 · 2018: 10 · 2017: 13 · 2016: 16 · 2015: 18 · 2014: 21 · 2013: 17 · 2012: 20
- FWCI
- 7.44
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- The HKU Scholars Hub (University of Hong Kong) (submittedVersion)
- Funders
- Pfizer
- National Health and Medical Research Council
- National Medical Research Council
- Health Research Council of New Zealand
- National Institute on Aging (P01 AG17625, P01AG017625)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- fasting blood glucose, cardiovascular risk, stroke, ischemic heart disease, regression dilution bias, Asian populations, cohort studies
- MeSH terms
- Aged, Asia, Blood Glucose, Cardiovascular Diseases, Fasting, Female, Humans, Male, Middle Aged, Pacific Ocean, Cohort Studies, Myocardial Ischemia, Risk Assessment, Stroke
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