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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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