title: A prospective study of low fasting glucose with cardiovascular disease events and all-cause mortality: The Women's Health Initiative.
abstract: While there is increasing recognition of the risks associated with hypoglycemia in patients with diabetes, few studies have investigated incident cause-specific cardiovascular outcomes with regard to low fasting glucose in the general population.
  
  
  
  We hypothesized that low fasting glucose would be associated with cardiovascular disease risk and all-cause mortality in postmenopausal women.
  
  
  
  To test our hypothesis, we used both continuous incidence rates and Cox proportional hazards models in 17,287 participants from the Women's Health Initiative with fasting glucose measured at baseline. Participants were separated into groups based on fasting glucose level: low (<80mg/dL), normal/reference (80-99mg/dL), impaired (100-125mg/dL), and diabetic (≥126mg/dL).
  
  
  
  Participants were free of cardiovascular disease at enrollment, had mean age of 62years, and were 52% Caucasian, 24% African American, 8% Asian, and 12% Hispanic. Median follow-up was 15years. Graphs of continuous incidence rates compared to fasting glucose distribution exhibited evidence of a weak J-shaped association with heart failure and mortality that was predominantly due to participants with treated diabetes. Impaired and diabetic fasting glucose were positively associated with all outcomes. Associations for low fasting glucose differed, with coronary heart disease (HR=0.64 (0.42, 0.98)) significantly inverse; stroke (0.73 (0.48, 1.13)), combined cardiovascular disease (0.91 (0.73, 1.14)), and all-cause mortality (0.97 (0.79, 1.20)) null or inverse and not significant; and heart failure (1.27 (0.80, 2.02)) positive and not significant.
  
  
  
  Fasting glucose at the upper range, but not the lower range, was significantly associated with incident cardiovascular disease and all-cause mortality.
authors.affiliation: Department of Medicine, University of California San Diego, San Diego, CA; Department of Epidemiology & Prevention, Wake Forest School of Medicine, Winston-Salem NC. Electronic address: mmongraw@wakehealth.edu.
authors.forename: Morgana
authors.initials: M
authors.lastname: Mongraw-Chaffin
authors.affiliation: Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA.
authors.forename: Andrea Z
authors.initials: AZ
authors.lastname: LaCroix
authors.affiliation: Department of Medicine, University of California San Diego, San Diego, CA; Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA.
authors.forename: Dorothy D
authors.initials: DD
authors.lastname: Sears
authors.affiliation: Department of Public Health Services, University of California Davis, Davis, CA.
authors.forename: Lorena
authors.initials: L
authors.lastname: Garcia
authors.affiliation: Atlanta VA Medical Center, Decatur, GA and Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA.
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Phillips
authors.affiliation: The Miriam Hospital Centers for Behavioral and Preventive Medicine at the Warren Alpert Medical School, Brown University, Providence, RI.
authors.forename: Elena
authors.initials: E
authors.lastname: Salmoirago-Blotcher
authors.affiliation: School of Nursing, University of Washington, Seattle, WA.
authors.forename: Oleg
authors.initials: O
authors.lastname: Zaslavsky
authors.affiliation: Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA.
authors.forename: Cheryl A M
authors.initials: CA
authors.lastname: Anderson
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D003920:Diabetes Mellitus; D005215:Fasting; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure; D006801:Humans; D007003:Hypoglycemia / Q000150:complications; D015994:Incidence; D008875:Middle Aged; D009026:Mortality; D017698:Postmenopause; D011446:Prospective Studies
chemical_list: D001786:Blood Glucose
keywords: Cardiovascular disease; Epidemiology; Fasting glucose; Heart failure