Relation between blood glucose and coronary mortality over 33 years in the Whitehall Study.
OBJECTIVE
Glucose intolerance is a risk factor for coronary disease, but there is uncertainty about the shape of the dose-response relationship between glucose level and risk of coronary mortality. We examined the prospective relation of 2-h postload blood glucose (2hBG) with coronary and other major causes of mortality over 33 years.


METHODS
A 50-g oral glucose tolerance test (OGTT) was performed at baseline (1967-1969) in 17,869 male civil servants aged 40-64 years.


RESULTS
There were 3,561 coronary deaths during 451,787 person-years of observation. All-cause, cardiovascular, and respiratory mortality were elevated among participants with glucose intolerance. The hazard of coronary mortality rose from 2hBG = 4.6 mmol/l (83 mg/dl [95% CI 4.2-5.3]). The dose-response relation was best fitted by a single slope above this level, with no evidence of nonlinearity, compared with Cox models using other threshold levels, and those containing log 2hBG terms. There was no evidence for a dose-response relationship below 2hBG = 4.6 mmol/l. Between this level and 11.1 mmol/l (200 mg/dl), the age-adjusted hazard ratio was 3.62 (95% CI 2.3-5.6). The graded relationship was attenuated by 45% after adjustment for baseline coronary heart disease (CHD), BMI, systolic blood pressure, blood cholesterol, smoking, physical activity, lung function, and employment grade.


CONCLUSIONS
A threshold model with linear slope best described the dose-response relationship between postload blood glucose and CHD mortality risk.
Brunner
Eric J
EJ
Department of Epidemiology and Public Health, University College London, UK. e.brunner@ucl.ac.uk
Shipley
Martin J
MJ
Witte
Daniel R
DR
Fuller
John H
JH
Marmot
Michael G
MG
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D001827:Body Height; D015992:Body Mass Index; D001835:Body Weight; D002423:Cause of Death; D003327:Coronary Disease / Q000401:mortality*; D005951:Glucose Tolerance Test; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000453:epidemiology; D008131:London / Q000453:epidemiology; D008875:Middle Aged; D012016:Reference Values; D012307:Risk Factors; D012907:Smoking; D016019:Survival Analysis
D001786:Blood Glucose