Hyperglycemia and stroke mortality: comparison between fasting and 2-h glucose criteria.
OBJECTIVE
We investigated stroke mortality in individuals in different categories of glycemia and compared hazard ratios (HRs) corresponding to a 1-SD increase in 2-h plasma glucose and fasting plasma glucose (FPG) criteria.


METHODS
We examined data from 2-h 75-g oral glucose tolerance tests taken from 13 European cohorts comprising 11,844 (55%) men and 9,862 (45%) women who were followed up for a median of 10.5 years. A multivariate adjusted Cox proportional hazards model was used to estimate HRs for stroke mortality.


RESULTS
In men and women without a prior history of diabetes, multivariate adjusted HRs for stroke mortality corresponding to a 1-SD increase in FPG were 1.02 (95% CI 0.83-1.25) and 1.52 (1.22-1.88) and those in 2-h plasma glucose 1.21 (1.06-1.38) and 1.31 (1.06-1.61), respectively. Addition of 2-h plasma glucose to the model with FPG significantly improved prediction of stroke mortality in men (chi2 = 10.12; P = 0.001) but not in women (chi2 = 0.01; P = 0.94), whereas addition of FPG to 2-h plasma glucose improved stroke mortality in women (chi2 = 4.08; P = 0.04) but not in men (chi2 = 3.29; P = 0.07).


CONCLUSIONS
Diabetes defined by either FPG or 2-h plasma glucose increases the risk of stroke mortality. In individuals without a history of diabetes, elevated 2-h postchallenge glucose is a better predictor than elevated fasting glucose in men, whereas the latter is better than the former in women.
Hyvärinen
Marjukka
M
Department of Public Health, University of Helsinki, Helsinki, Finland. marjukka.hyvarinen@helsinki.fi
Qiao
Qing
Q
Tuomilehto
Jaakko
J
Laatikainen
Tiina
T
Heine
Robert J
RJ
Stehouwer
Coen D A
CD
Alberti
K George M M
KG
Pyörälä
Kalevi
K
Zethelius
Björn
B
Stegmayr
Birgitta
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis / Q000378:metabolism; D003327:Coronary Disease / Q000401:mortality; D005060:Europe / Q000453:epidemiology; D005215:Fasting; D005260:Female; D005500:Follow-Up Studies; D005951:Glucose Tolerance Test; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012044:Regression Analysis; D020521:Stroke / Q000401:mortality*; D013997:Time Factors
D001786:Blood Glucose