title: J-shaped association between plasma glucose concentration and cardiovascular disease mortality over a follow-up of 32years.
abstract: OBJECTIVE
  We aimed at examining the association between plasma glucose (PG) concentration and cardiovascular mortality in a population sample from Switzerland over a follow-up time of 32 years.
  
  
  METHODS
  We analyzed 7984 men and women enrolled in the first National Research Program (NRP1A, 1977-1979) and followed up for survival until 2008. Mortality hazard ratios (HR) were calculated using adjusted Cox regression models. PG was measured in fasting state or randomly with known fasting time. Models were adjusted for age, sex, socio-demographic, lifestyle and cardiovascular risk factors.
  
  
  RESULTS
  PG concentrations ≥ 6.1 mmol/L were associated with increased risk of cardiovascular disease (CVD) and all-cause mortality. Compared to normal PG (3.8-4.9 mmol/L) the adjusted HR (95% CI) for CVD mortality was 1.26 (1.01-1.58) for PG ≥ 6.1-6.9 mmol/L, 1.56 (1.18-2.06) for PG ≥ 7 mmol/L, 1.67 (1.22-2.30) for known diabetes. All-cause mortality essentially showed the same patterns. All-cause mortality was increased [1.35 (1.01-1.80)] also for PG <3.8 mmol/L.
  
  
  CONCLUSIONS
  Plasma glucose remained significantly and independently associated with CVD mortality even after full follow-up. The relationship was J-shaped. In order to prevent premature death, persons with abnormal PG concentrations on both extremes should be screened and counseled for other CVD risk factors.
authors.affiliation: 3052 Zollikofen, Switzerland.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: von Gunten
authors.forename: Julia
authors.initials: J
authors.lastname: Braun
authors.forename: Matthias
authors.initials: M
authors.lastname: Bopp
authors.forename: Ulrich
authors.initials: U
authors.lastname: Keller
authors.forename: David
authors.initials: D
authors.lastname: Faeh
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000097:blood* / Q000401:mortality* / Q000517:prevention & control; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006293:Health Promotion; D006306:Health Surveys; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D013557:Switzerland
chemical_list: D001786:Blood Glucose
keywords: Cardiovascular risk factors; Diabetes mellitus; Follow-up; Glucose; Lifestyle; Mortality; Switzerland