Is there a glycemic threshold for mortality risk?
OBJECTIVE
To determine whether there are thresholds for fasting and for 2-h glucose above which the risk of death from all causes and from coronary heart disease (CHD) increases.


METHODS
We studied 23-year mortality data from the Paris Prospective Study of the 7,018 men, aged 44-55 years, who were not known as diabetic at the baseline examination. The effect of glucose concentrations on mortality was studied using the observed relative risks and an age-adjusted Cox proportional hazards model.


RESULTS
For all causes of death, there were J-shaped relationships with both fasting and 2-h glucose concentrations, and the lowest observed death rates were in the intervals centered on 5.5 mmol/l for fasting glucose and 5.0 mmol/l for 2-h glucose. The death rates for CHD were low in this population: for fasting glucose, the hazards ratio was best modeled by a positive linear relationship; for 2-h glucose, it was modeled by a J-shaped curve and the lowest observed death rate was in the interval centered on 6.0 mmol/l.


CONCLUSIONS
In the Paris Prospective Study, there were no clear thresholds for fasting or 2-h glucose concentrations above which mortality sharply increased; in the upper levels of the glucose distributions, the risk of death progressively increased with increasing fasting and 2-h glucose concentrations.
Balkau
B
B
Institut National de la Santé et de la Recherche Médicale (INSERM) U258, Villejuif, France. balkau@vjf.inserm.fr
Bertrais
S
S
Ducimetiere
P
P
Eschwege
E
E
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D002423:Cause of Death; D003327:Coronary Disease / Q000401:mortality*; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000097:blood*; D018149:Glucose Intolerance / Q000097:blood* / Q000150:complications; D005951:Glucose Tolerance Test; D006801:Humans; D008297:Male; D008875:Middle Aged; D010297:Paris; D011446:Prospective Studies; D012307:Risk Factors
D001786:Blood Glucose