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Randomized Controlled Trial
. 2010 May;31(10):1230-6.
doi: 10.1093/eurheartj/ehq095. Epub 2010 Apr 15.

Fasting plasma glucose in non-diabetic participants and the risk for incident cardiovascular events, diabetes, and mortality: results from WOSCOPS 15-year follow-up

David Preiss  1 , Paul Welsh, Heather M Murray, James Shepherd, Chris Packard, Peter Macfarlane, Stuart Cobbe, Ian Ford, Naveed Sattar
Affiliations
Randomized Controlled Trial

Fasting plasma glucose in non-diabetic participants and the risk for incident cardiovascular events, diabetes, and mortality: results from WOSCOPS 15-year follow-up

David Preiss et al. Eur Heart J. 2010 May.

Abstract

Aims: The evidence base for fasting plasma glucose (FPG) in the non-diabetic range as a risk factor for cardiovascular disease (CVD) is inconclusive. We investigated this question in the West of Scotland Coronary Prevention Study (WOSCOPS).

Methods and results: In WOSCOPS, we related FPG in 6447 men (mean age 55 years) with hypercholesterolaemia, but no history of CVD or diabetes, to the risk of cardiovascular events and mortality over 14.7 years of follow-up; 2381 non-fatal/fatal cardiovascular events and 1244 deaths occurred. Participants were divided into fifths of baseline FPG, Q1 (< or =4.3 mmol/L) to Q5 (>5.1-6.9 mmol/L). Q2 was designated the referent based on previous studies which have suggested a J-shaped relationship between FPG and CVD. Compared with Q2 (>4.3-4.6 mmol/L), men in Q5 had no elevated risk for cardiovascular events [hazard ratio (HR) 0.95 (0.83-1.08)], or all-cause mortality [HR 0.96 (0.80-1.15)] in fully adjusted analyses despite a significant risk for incident diabetes [HR 22.05 (10.75-45.22)]. After further dividing Q5 into fifths, Q5a-e, individuals in Q5e (FPG 5.8-6.9 mmol/L) were also not at increased risk of cardiovascular events [HR 1.05 (0.82-1.35)] or other endpoints compared with Q2. All results were similar using Q1 as the referent.

Conclusion: Elevations in FPG in the non-diabetic range were not associated with long-term risk of cardiovascular events in middle-aged men in WOSCOPS. These data suggest that the current FPG cutoff for diagnosing diabetes also appropriately identifies western men at risk of CVD.

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Figure 1
Figure 1. Risk of CVD over 15 years compared to risk of diabetes over 5 years by baseline FPG levels (fully adjusted model)*
Footnote: * note that Q1, Q3, Q4, Q5 data are all compared to referent Q2 (FPG >4.3-4.6mmol/L) whereas CVD risk for baseline diabetic patients is compared to all non-diabetic individuals
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