title: Does non-diabetic hyperglycemia predict future IHD? Evidence from the Caerphilly and Speedwell studies.
abstract: We have examined the risk of subsequent ischemic heart disease (IHD) in men according to their initial fasting plasma glucose level in a prospective cohort study (Caerphilly Collaborative Study) of 4860 middle aged men from South Wales and Bristol, U.K. Ninety-four men reported themselves to be diabetic at initial screening and fasting venous plasma glucose levels were determined in these men and in a further 4519 non-diabetic men. At follow-up new IHD events occurred twice as commonly in diabetics compared to non-diabetics and overall mortality was increased 4-fold. Among non-diabetics however, increased IHD events only occurred in men with fasting values at the upper end of the distribution of baseline plasma glucose values [at 6.8 mmol/l (122 mg/dl) or more]. This association was reduced, but remained statistically significant, after adjusting for factors associated with plasma glucose levels; body mass index, plasma triglyceride, smoking habit and pre-existing IHD. In conclusion there is no evidence of a consistent, graded increase in risk of IHD by initial fasting plasma glucose level although the risk is significantly increased in men with baseline plasma values at 6.8 mmol/l (122 mg/dl) or more, and also in diabetics. This study suggests that such levels probably represent a pre-diabetic state in many individuals. Appropriate non-pharmacological intervention may be useful in halting the progression to the diabetic state, although this should be tested in experimental studies.
authors.affiliation: MRC Epidemiology Unit, Llandough Hospital, Penarth, South Glamorgan, U.K.
authors.forename: J W
authors.initials: JW
authors.lastname: Yarnell
authors.forename: J E
authors.initials: JE
authors.lastname: Pickering
authors.forename: P C
authors.initials: PC
authors.lastname: Elwood
authors.forename: I A
authors.initials: IA
authors.lastname: Baker
authors.forename: D
authors.initials: D
authors.lastname: Bainton
authors.forename: C
authors.initials: C
authors.lastname: Dawkins
authors.forename: D I
authors.initials: DI
authors.lastname: Phillips
mesh_terms: D001786:Blood Glucose / Q000032:analysis*; D015331:Cohort Studies; D048909:Diabetes Complications; D005215:Fasting; D006801:Humans; D006943:Hyperglycemia / Q000150:complications; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis*; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D001786:Blood Glucose