title: Association of Random Plasma Glucose Levels With the Risk for Cardiovascular Disease Among Chinese Adults Without Known Diabetes.
abstract: Diabetes is a known risk factor for cardiovascular disease (CVD). Substantial uncertainty remains, however, about the relevance to CVD risk for blood glucose levels below the diabetes threshold.
  
  
  
  To examine the association of random plasma glucose (RPG) levels with the risk for major CVD in Chinese adults without known diabetes.
  
  
  
  This prospective cohort study included 467 508 men and women aged 30 to 79 years with no history of diabetes, ischemic heart disease (IHD), stroke, or transient ischemic attack. Participants were recruited from 5 urban and 5 rural diverse locations across China from June 25, 2004, to July 15, 2008, and followed up to January 1, 2014.
  
  
  
  Baseline and usual (longer-term average) RPG level.
  
  
  
  Cardiovascular deaths, major coronary events (MCE) (including fatal IHD and nonfatal myocardial infarction), ischemic stroke (IS), major occlusive vascular disease (MOVD) (including MCE or IS), and intracerebral hemorrhage. Preliminary validation of stroke and IHD events demonstrated positive predictive values of approximately 90% and 85%, respectively. Cox regression yielded adjusted hazard ratios (aHRs) for CVD associated with RPG levels.
  
  
  
  Among the 467 508 participants (41.0% men; 59.0% women; mean [SD] age, 51 [11] years), a significant positive association of baseline RPG levels with CVD risks continued to 4.0 mmol/L (72 mg/dL). After adjusting for regression dilution bias, each 1-mmol/L (18-mg/dL) higher usual RPG level above 5.9 mmol/L (106 mg/dL) was associated with an 11% higher risk for cardiovascular death (6645 deaths; aHR, 1.11; 95% CI, 1.10-1.13). Similarly strong positive associations were seen for MCE (3270 events; aHR, 1.10; 95% CI, 1.08-1.13), IS (19 153 events; aHR, 1.08; 95% CI, 1.07-1.09), and MOVD (22 023 events; aHR, 1.08; 95% CI, 1.07-1.09). For intracerebral hemorrhage, the association was weaker, but also significant (4326 events; aHR, 1.05; 95% CI, 1.02-1.07). These associations persisted after excluding participants who developed diabetes during follow-up.
  
  
  
  Among adult Chinese without diabetes, lower RPG levels are associated with lower risks for major CVDs, even within a normal range of blood glucose levels.
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England.
authors.forename: Fiona
authors.initials: F
authors.lastname: Bragg
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China3Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Liming
authors.initials: L
authors.lastname: Li
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England.
authors.forename: Derrick
authors.initials: D
authors.lastname: Bennett
authors.affiliation: Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Guo
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England.
authors.forename: Sarah
authors.initials: S
authors.lastname: Lewington
authors.affiliation: Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Bian
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England.
authors.forename: Ling
authors.initials: L
authors.lastname: Yang
authors.affiliation: China National Center for Food Safety Risk Assessment, Beijing, China.
authors.forename: Junshi
authors.initials: J
authors.lastname: Chen
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England.
authors.forename: Yiping
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England.
authors.forename: Rory
authors.initials: R
authors.lastname: Collins
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England.
authors.forename: Richard
authors.initials: R
authors.lastname: Peto
authors.affiliation: Henan Centre for Disease Control and Prevention, Zhengzhou, China.
authors.forename: Baoyu
authors.initials: B
authors.lastname: Zhu
authors.affiliation: Heilongjiang Centre for Disease Control and Prevention, Harbin, China.
authors.forename: Jiyuan
authors.initials: J
authors.lastname: Yin
authors.affiliation: Hainan Centre for Disease Control and Prevention, Haikou, China.
authors.forename: Ximin
authors.initials: X
authors.lastname: Hu
authors.affiliation: Liuzhou Centre for Disease Control and Prevention, Liuzhou, China.
authors.forename: Liyuan
authors.initials: L
authors.lastname: Zhou
authors.affiliation: Tongxiang Centre for Disease Control and Prevention, Tongxiang, China.
authors.forename: Yaxing
authors.initials: Y
authors.lastname: Pan
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England.
authors.forename: Zhengming
authors.initials: Z
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002681:China / Q000453:epidemiology; D048909:Diabetes Complications; D003920:Diabetes Mellitus; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D001786:Blood Glucose