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Fasting and 2-Hour Postchallenge Serum Glucose Measures and Risk of Incident Cardiovascular Events in the Elderly
The Cardiovascular Health Study
Nicholas L. Smith, PhD, MPH;
Joshua I. Barzilay, MD;
Douglas Shaffer, MD, MHS;
Peter J. Savage, MD;
Susan R. Heckbert, MD, PhD;
Lewis H. Kuller, MD, DrPH;
Richard A. Kronmal, PhD;
Helaine E. Resnick, PhD, MPH;
Bruce M. Psaty, MD, PhD
Arch Intern Med. 2002;162:209-216.
Background The contributions of fasting and 2-hour postchallenge glucose level
to cardiovascular events remain ill-defined, especially for nondiabetic adults.
This study examined the relative predictive power of fasting and 2-hour glucose
level on cardiovascular event risk.
Methods A total of 4014 community-dwelling adults 65 years or older who participated
in the baseline visit of the Cardiovascular Health Study and who were without
treated diabetes or previous myocardial infarction or stroke were eligible
for analyses. Participants with treated diabetes at baseline were excluded.
Incident myocardial infarction or stroke, or coronary death, was the outcome
of interest. Age-, sex-, and race-adjusted proportional hazards regression
models described individual and joint associations between baseline measures
of fasting and 2-hour postchallenge glucose level and event risk.
Results There were 764 incident cardiovascular events during 8.5 years of follow-up.
Fasting glucose level of 115 mg/dL (6.4 mmol/L) or more was associated with
an increased cardiovascular risk (hazard ratio [HR], 1.66 [95% confidence
interval (CI), 1.39-1.98]) in adjusted analyses compared with fasting glucose
level less than 115 mg/dL. Two-hour glucose level was associated with a linear
risk (HR, 1.02 [95% CI, 1.00-1.04] per 10 mg/dL [0.6 mmol/L]) that included
an additional increase in risk for 2-hour glucose level of 154 mg/dL (8.5
mmol/L) or more (HR, 1.29 [95% CI, 1.04-1.59]) in adjusted analyses. In joint
fasting and 2-hour glucose models, only 2-hour glucose level remained predictive
of event risk.
Conclusions Two-hour glucose level was better than fasting glucose level alone at
identifying older adults at increased risk of major incident cardiovascular
events.
From the Departments of Epidemiology (Drs Smith, Heckbert, and Psaty),
Medicine (Dr Psaty), Biostatistics (Dr Kronmal), and Health Services (Dr Psaty),
University of Washington, Seattle; Division of Endocrinology, Kaiser Permanente
of Georgia, Atlanta (Dr Barzilay); Division of Epidemiology and Clinical Applications,
National Heart, Lung, and Blood Institute, Bethesda, Md (Drs Shaffer and Savage);
Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pa (Dr Kuller);
and Epidemiology, Demography, and Biometry Program, National Institute on
Aging, Bethesda (Dr Resnick).
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