Association between fasting blood glucose levels and stroke events: a large-scale community-based cohort study from China

Abstract

Objectives: Diabetes mellitus has been associated with stroke. However, the association between fasting blood glucose (FBG) and stroke risk in a general population remains not clear. The purpose of our study was to examine the FBG levels on subsequent stroke risk in a community-based cohort in China.

Design: Prospective cohort study, employing Cox proportional hazard model to analyse the association of FBG levels with stroke risk.

Setting: A community-based cohort study included adults participating in a baseline survey conducted in 2013 in Changshu, eastern China.

Participants: 16 113 participants were recruited with a multistage sampling method, excluding participants with severe disability, severe cancer, severe psychiatric disturbance or previous stroke before enrolment.

Primary outcome measures: Stroke events.

Results: During a median follow-up of 5.5 years, 417 incident cases of stroke were identified. The adjusted HR for total and ischaemic stroke for participants in the fourth quartile of FBG compared with the first quartile was 1.44 (95% CI 1.07 to 1.94) and 1.57 (95% CI 1.11 to 2.21), respectively. FBG levels of ≥7.0 mmol/L were associated with an increased risk of stroke based on two clinical classifications (American Diabetes Association: 1.68 (1.24 to 2.27); WHO: 1.62 (1.21, 2.13)). In stratified analyses, risk associations existed in women (HR: 1.92, 95% CI 1.22 to 3.01) and postmenopausal women (HR: 1.68, 95% CI 1.06 to 2.68) for the fourth quartile versus the first. More importantly, the meta-analysis observed a positive association between FBG levels and stroke risk (pooled HR: 1.70, 95% CI 1.27 to 2.29; n=7)).

Conclusions: Higher FBG level was independently associated with an increased risk of stroke in Chinese adults, especially significant in women.

Keywords: diabetes & endocrinology; epidemiology; stroke.

Figure 1

Meta-analysis of fasting blood glucose at the highest vs lowest levels and the risk of developing stroke. The horizontal lines indicate the lower and upper limits of the 95% CI, and the grey squares reflect the HR of each study.