Hyperglycaemia is associated with all-cause and cardiovascular mortality in the hoorn population : the Hoorn Study

• Published in: Diabetologia 1999-08, Vol.42 (8), p.926-931
• Main Authors: DE VEGT, F, DEKKER, J. M, RUHE, H. G, STEHOUWER, C. D. A, NIJPELS, G, BOUTER, L. M, HEINE, R. J
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Blood Glucose - analysis; Blood Glucose - metabolism; Cardiovascular disease; Cardiovascular Diseases - mortality; Cohort Studies; Diabetes; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; European Continental Ancestry Group; Fasting; Female; Follow-Up Studies; Glucose; Glucose Tolerance Test; Glycated Hemoglobin A - analysis; Hospitals; Humans; Hyperglycemia; Hyperglycemia - blood; Hyperglycemia - diagnosis; Hyperglycemia - epidemiology; Hypertension; Insulin; Male; Medical sciences; Middle Aged; Mortality; Netherlands - epidemiology; Patient Selection; Plasma; Predictive Value of Tests; Risk Assessment; Risk Factors; Smoking; Urban Population; Womens health
• ISSN: 0012-186X; 1432-0428
• DOI: 10.1007/s001250051249

The degree of glycaemia has been shown to be associated with all-cause and cardiovascular mortality in diabetic subjects. Whether this association also exists in the general population is still controversial. We studied the predictive value of fasting plasma glucose, 2-hour post-load glucose and HbA1c in a population-based cohort of 2363 older (50-75 years) subjects, without known diabetes. Relative risks (RR) of all-cause and cardiovascular mortality were estimated by Cox proportional hazards model, adjusting for age and sex, and additionally for known cardiovascular risk factors. During 8 years of follow-up, 185 subjects died; 98 of cardiovascular causes. Fasting plasma glucose was only predictive in the diabetic range, although the risks started to increase at about 6.1 mmol/l. Post-load glucose and HbA1c values were, even within the non-diabetic range, associated with an increased risk (p for linear trend < 0.05). These increased risks were mostly, but not completely, attributable to known cardiovascular risk factors. After exclusion of subjects with newly diagnosed diabetes or with pre-existent cardiovascular disease (n = 551), a 5.8 mmol/l increase of post-load glucose (corresponding to two standard deviations of the population distribution) was associated with a higher age-adjusted and sex-adjusted risk of all-cause (RR 2.24) and cardiovascular mortality (RR 3.40) (p < 0.05). After additional adjustment for known cardiovascular risk factors, these relative risks were still statistically significant, with values of 2.20 and 3.00 respectively (p < 0.05). High glycaemic variables, especially 2-h post-load glucose concentrations and to a lesser extent HbA1c values, indicate a risk of all-cause and cardiovascular mortality in a general population without known diabetes.