Postprandial glucose improves the risk prediction of cardiovascular death beyond the metabolic syndrome in the nondiabetic population.
OBJECTIVE
With increasing evidence about the cardiovascular risk associated with postprandial nonfasting glucose and lipid dysmetabolism, it remains uncertain whether the postprandial glucose concentration increases the ability of metabolic syndrome to predict cardiovascular events.


METHODS
This was an observational study of 15,145 individuals aged 35-75 years without diabetes or cardiovascular diseases. Postprandial glucose was obtained 2 h after a lunch meal. Metabolic syndrome was diagnosed using the criteria of the U.S. National Cholesterol Education Program Adult Treatment Panel III. Cardiovascular and all-cause deaths were primary outcomes.


RESULTS
During a median follow-up of 6.7 years, 410 individuals died, including 82 deaths from cardiovascular causes. In a Cox model adjusting for metabolic syndrome status as well as age, sex, smoking, systolic blood pressure, LDL, and HDL cholesterol levels, elevated 2-h postprandial glucose increased the risk of cardiovascular and all-cause death (per millimole per liter increase, hazard ratio 1.26 [95% CI 1.11-1.42] and 1.10 [1.04-1.16], respectively), with significant trends across the postprandial glucose quintiles. Including 2-h postprandial glucose into a metabolic syndrome-included multivariate risk prediction model conferred a discernible improvement of the model in discriminating between those who died of cardiovascular causes and who did not (integrated discrimination improvement 0.4, P = 0.005; net reclassification improvement 13.4%, P = 0.03); however, the improvement was only marginal for all-cause death.


CONCLUSIONS
Given the risk prediction based on metabolic syndrome and established cardiovascular risk factors, 2-h postprandial glucose improves the predictive ability to identity nondiabetic individuals at increased risk of cardiovascular death.
Lin
Hung-Ju
HJ
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Lee
Bai-Chin
BC
Ho
Yi-Lwun
YL
Lin
Yen-Hung
YH
Chen
Ching-Yi
CY
Hsu
Hsiu-Ching
HC
Lin
Mao-Shin
MS
Chien
Kuo-Liong
KL
Chen
Ming-Fong
MF
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000097:blood* / Q000209:etiology / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood* / Q000503:physiopathology*; D008875:Middle Aged; D015999:Multivariate Analysis; D019518:Postprandial Period
D001786:Blood Glucose