title: A progressive increase in cardiovascular risk assessed by coronary angiography in non-diabetic patients at sub-diabetic glucose levels.
abstract: OBJECTIVE
  Diabetes mellitus type 2 (DM2) is a risk factor for coronary heart disease (CHD). While there is a clear correlation of fasting blood glucose (FBG) and 2 h post-challenge blood glucose values (2h-BG) with microvascular complications, the risk for CHD conferred by glucose dysregulation antecedent to DM2 is less clear. Therefore, we investigated associations of FBG and 2h-BG values with the prevalence of CHD assessed by coronary angiography as the most sensitive diagnostic tool.
  
  
  METHODS
  Coronary angiography was performed in 1394 patients without known DM. Capillary blood glucose was analyzed before and 2 h after an oral glucose tolerance test. Associations between FBG as well as 2h-BG levels and the risk for CHD were assessed by logistic regression analysis.
  
  
  RESULTS
  1064 (75%) of patients were diagnosed with CHD. 204 (15%) were diagnosed with so far unknown DM2, 274 (20%) with isolated impaired fasting glucose (IFG), 188 (13%) with isolated impaired glucose tolerance (IGT) and 282 (20%) with both, IGT and IFG. We found a continuous increase in the risk for CHD with fasting and post-challenge blood glucose values even in the subdiabetic range. This correlation did however not suggest clear cut-off values. The increase in risk for CHD reached statistical significance at FBG levels of > 120 mg/dl (Odds Ratio of 2.7 [1.3-5.6] and 2h-BG levels > 140 mg/dl (141-160 mg/dl OR 1.8 [1.1-2.9], which was however lost after adjusting for age, sex and BMI.
  
  
  CONCLUSIONS
  In our study population we found a continuous increased risk for CHD at fasting and 2h-BG levels in the sub-diabetic glucose range, but no clear cut-off values for cardiovascular risk.
authors.affiliation: Department of Endocrinology, Diabetes and Rheumatology, University Hospital Düsseldorf, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Schinner
authors.forename: Reiner
authors.initials: R
authors.lastname: Füth
authors.forename: Kerstin
authors.initials: K
authors.lastname: Kempf
authors.forename: Stephan
authors.initials: S
authors.lastname: Martin
authors.forename: Holger S
authors.initials: HS
authors.lastname: Willenberg
authors.forename: Matthias
authors.initials: M
authors.lastname: Schott
authors.forename: Wilfried
authors.initials: W
authors.lastname: Dinh
authors.forename: Werner A
authors.initials: WA
authors.lastname: Scherbaum
authors.forename: Mark
authors.initials: M
authors.lastname: Lankisch
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000150:complications*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D001786:Blood Glucose