title: Fasting plasma glucose and incident heart failure risk: a population-based cohort study and new meta-analysis.
abstract: BACKGROUND
  There remains uncertainty regarding the association between fasting plasma glucose (FPG) and risk of heart failure (HF) in individuals without a history of diabetes.
  
  
  RESULTS
  We assessed the association between FPG and HF risk in a population-based cohort of 1,740 men aged 42-61 years who were free from HF or diabetes at baseline. During a mean follow-up of 20.4 years, 146 participants developed HF. In age-adjusted analysis, the hazard ratio (HR) for HF per 1 mmol/L increase in FPG was 1.34 (95% confidence interval 1.22-1.48). This association persisted after adjusting for established HF risk factors: HR 1.27, 95% confidence interval 1.14-1.42. The findings remained consistent across several clinical subgroups and in analyses excluding incident coronary heart disease or diabetes during follow-up. In a meta-analysis of 10 prospective studies involving 4,213 incident HF cases, the HR for HF per 1 mmol/L increase in FPG level was 1.11 (95% confidence interval 1.04-1.17), with evidence of heterogeneity between studies (I(2) = 79%; 95% confidence interval 63%-89%; P < .001). The corresponding HR was 1.12 (95% confidence interval 1.08-1.18) on exclusion of the single study that accounted for the heterogeneity.
  
  
  CONCLUSIONS
  There exists a positive, continuous, and independent association between FPG and risk for HF. Studies are warranted to evaluate the causal relevance of these findings.
authors.affiliation: Department of Public Health and Primary Care, University of Cambridge, United Kingdom. Electronic address: drhasankhan@gmail.com.
authors.forename: Hassan
authors.initials: H
authors.lastname: Khan
authors.affiliation: Department of Public Health and Primary Care, University of Cambridge, United Kingdom.
authors.forename: Setor K
authors.initials: SK
authors.lastname: Kunutsor
authors.affiliation: Kuopio Research Institute of Exercise Medicine, Kuopio, Finland.
authors.forename: Jussi
authors.initials: J
authors.lastname: Kauhanen
authors.affiliation: Kuopio Research Institute of Exercise Medicine, Kuopio, Finland.
authors.forename: Sudhir
authors.initials: S
authors.lastname: Kurl
authors.affiliation: Cleveland Clinic, Cleveland, Ohio.
authors.forename: Eiran Z
authors.initials: EZ
authors.lastname: Gorodeski
authors.affiliation: Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, United Kingdom.
authors.forename: Amanda I
authors.initials: AI
authors.lastname: Adler
authors.affiliation: Emory University, Atlanta, Georgia.
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
authors.affiliation: Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Department of Internal Medicine, Lapland Central Hospital, Rovaniemi, Finland.
authors.forename: Jari A
authors.initials: JA
authors.lastname: Laukkanen
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D005215:Fasting / Q000097:blood*; D005500:Follow-Up Studies; D014943:Global Health; D006333:Heart Failure / Q000097:blood* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D011159:Population Surveillance; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D001786:Blood Glucose
keywords: Fasting plasma glucose; diabetes; heart failure; meta-analysis; risk factor