title: Increased Vascular Disease Mortality Risk in Prediabetic Korean Adults Is Mainly Attributable to Ischemic Stroke.
abstract: Prediabetes is a known risk factor for vascular diseases; however, its differential contribution to mortality risk from various vascular disease subtypes is not known.
  
  
  
  The subjects of the National Health Insurance Service in Korea (2002-2013) nationwide cohort were stratified into normal glucose tolerance (fasting glucose <100 mg/dL), impaired fasting glucose (IFG) stage 1 (100-109 mg/dL), IFG stage 2 (110-125 mg/dL), and diabetes mellitus groups based on the fasting glucose level. A Cox regression analysis with counting process formulation was used to assess the mortality risk for vascular disease and its subtypes-ischemic heart disease, ischemic stroke, and hemorrhagic stroke.
  
  
  
  When adjusted for age, sex, and body mass index, IFG stage 2, but not stage 1, was associated with significantly higher all-cause mortality (hazard ratio [HR], 1.26; 95% confidence interval [CI], 1.18-1.34) and vascular disease mortality (HR, 1.27; 95% CI, 1.08-1.49) compared with normal glucose tolerance. Among the vascular disease subtypes, mortality from ischemic stroke was significantly higher (HR, 1.60; 95% CI, 1.18-2.18) in subjects with IFG stage 2 but not from ischemic heart disease and hemorrhagic stroke. The ischemic stroke mortality associated with IFG stage 2 remained significantly high when adjusted other modifiable vascular disease risk factors (HR, 1.51; 95% CI: 1.10-2.09) and medical treatments (HR, 1.75; 95% CI, 1.19-2.57).
  
  
  
  Higher IFG degree (fasting glucose, 110-125 mg/dL) was associated with increased all-cause and vascular disease mortality. The increased vascular disease mortality in IFG stage 2 was attributable to ischemic stroke, but not ischemic heart disease or hemorrhagic stroke in Korean adults.
authors.affiliation: From the Division of Endocrinology and Metabolism, Department of Internal Medicine (Nam Hoon Kim, Nan Hee Kim, K.M.C., S.H.B., S.G.K.) and Department of Neurology (S.Y.), Korea University College of Medicine, Seoul, Korea; Division of International Finance, Hankuk University of Foreign Studies, Seoul, Korea (T.Y.K.); and Department of Statistics, Korea University, Seoul, Korea (Y.P.).
authors.forename: Nam Hoon
authors.initials: NH
authors.lastname: Kim
authors.affiliation: From the Division of Endocrinology and Metabolism, Department of Internal Medicine (Nam Hoon Kim, Nan Hee Kim, K.M.C., S.H.B., S.G.K.) and Department of Neurology (S.Y.), Korea University College of Medicine, Seoul, Korea; Division of International Finance, Hankuk University of Foreign Studies, Seoul, Korea (T.Y.K.); and Department of Statistics, Korea University, Seoul, Korea (Y.P.).
authors.forename: Tae Yeon
authors.initials: TY
authors.lastname: Kwon
authors.affiliation: From the Division of Endocrinology and Metabolism, Department of Internal Medicine (Nam Hoon Kim, Nan Hee Kim, K.M.C., S.H.B., S.G.K.) and Department of Neurology (S.Y.), Korea University College of Medicine, Seoul, Korea; Division of International Finance, Hankuk University of Foreign Studies, Seoul, Korea (T.Y.K.); and Department of Statistics, Korea University, Seoul, Korea (Y.P.).
authors.forename: Sungwook
authors.initials: S
authors.lastname: Yu
authors.affiliation: From the Division of Endocrinology and Metabolism, Department of Internal Medicine (Nam Hoon Kim, Nan Hee Kim, K.M.C., S.H.B., S.G.K.) and Department of Neurology (S.Y.), Korea University College of Medicine, Seoul, Korea; Division of International Finance, Hankuk University of Foreign Studies, Seoul, Korea (T.Y.K.); and Department of Statistics, Korea University, Seoul, Korea (Y.P.).
authors.forename: Nan Hee
authors.initials: NH
authors.lastname: Kim
authors.affiliation: From the Division of Endocrinology and Metabolism, Department of Internal Medicine (Nam Hoon Kim, Nan Hee Kim, K.M.C., S.H.B., S.G.K.) and Department of Neurology (S.Y.), Korea University College of Medicine, Seoul, Korea; Division of International Finance, Hankuk University of Foreign Studies, Seoul, Korea (T.Y.K.); and Department of Statistics, Korea University, Seoul, Korea (Y.P.).
authors.forename: Kyung Mook
authors.initials: KM
authors.lastname: Choi
authors.affiliation: From the Division of Endocrinology and Metabolism, Department of Internal Medicine (Nam Hoon Kim, Nan Hee Kim, K.M.C., S.H.B., S.G.K.) and Department of Neurology (S.Y.), Korea University College of Medicine, Seoul, Korea; Division of International Finance, Hankuk University of Foreign Studies, Seoul, Korea (T.Y.K.); and Department of Statistics, Korea University, Seoul, Korea (Y.P.).
authors.forename: Sei Hyun
authors.initials: SH
authors.lastname: Baik
authors.affiliation: From the Division of Endocrinology and Metabolism, Department of Internal Medicine (Nam Hoon Kim, Nan Hee Kim, K.M.C., S.H.B., S.G.K.) and Department of Neurology (S.Y.), Korea University College of Medicine, Seoul, Korea; Division of International Finance, Hankuk University of Foreign Studies, Seoul, Korea (T.Y.K.); and Department of Statistics, Korea University, Seoul, Korea (Y.P.).
authors.forename: Yousung
authors.initials: Y
authors.lastname: Park
authors.affiliation: From the Division of Endocrinology and Metabolism, Department of Internal Medicine (Nam Hoon Kim, Nan Hee Kim, K.M.C., S.H.B., S.G.K.) and Department of Neurology (S.Y.), Korea University College of Medicine, Seoul, Korea; Division of International Finance, Hankuk University of Foreign Studies, Seoul, Korea (T.Y.K.); and Department of Statistics, Korea University, Seoul, Korea (Y.P.). k50367@korea.ac.kr yspark433@gmail.com.
authors.forename: Sin Gon
authors.initials: SG
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose; D002545:Brain Ischemia / Q000097:blood / Q000453:epidemiology / Q000401:mortality*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000706:statistics & numerical data; D011236:Prediabetic State / Q000097:blood / Q000453:epidemiology / Q000401:mortality*; D056910:Republic of Korea / Q000453:epidemiology; D020521:Stroke / Q000097:blood / Q000453:epidemiology / Q000401:mortality*
chemical_list: D001786:Blood Glucose
keywords: diabetes mellitus; glucose tolerance; stroke