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Impaired Fasting Glucose Increases Risk Factors for CVD Mortality

Posted: Saturday, July 14, 2007

New studies are showing that we must treat impaired fasting glucose more aggressively.

Diabetes mellitus is a well-established risk factor for cardiovascular disease (CVD) and all-cause mortality. These Australian investigators sought to compare the mortality risks of diabetes with those of less marked levels of hyperglycemia, impaired fasting glucose and impaired glucose tolerance while adjusting for concomitant CVD risk factors. The population-based sample of more than 11,000 people 25 years and older included demographic, health history, anthropomorphic, and laboratory data collected on enrollment in 1999-2000. Categories of abnormal glucose metabolism were determined based on 1999 World Health Organization criteria. These data were linked to the Australian National Death Index through June 2005. Persons not appearing in the death index were assumed to be alive.

Follow-up was a median of 5.2 years. Deaths in persons 25-44 were too low for meaningful analysis. For those 65 or over deaths were higher in diabetics, but otherwise there was not a consistent picture. After adjusting for age, sex and other established CVD risk factors, diabetes and impaired fasting glucose were both independent risk factors for CVD mortality with similar hazard ratios, but impaired glucose tolerance was not.

The authors concluded: “This study emphasizes the strong association between abnormal glucose metabolism and mortality, and it suggests that this condition contributes to a large number of CVD deaths in the general population. CVD prevention may be warranted in people with all categories of abnormal glucose metabolism.”

This study demonstrates the need for intervention trials to prevent CVD mortality in patients with impaired fasting glucose.

Source: Diabetes In Control: Circulation. 2007;116: June 2007.Risk of Cardiovascular and All-Cause Mortality in Individuals With Diabetes Mellitus, Impaired Fasting Glucose, and Impaired Glucose Tolerance. The Australian Diabetes, Obesity, and Lifestyle Study (AusDiab), E.L.M. Barr MPH, P.Z. Zimmet PhD, T.A. Welborn PhD, D. Jolley MSc, D.J. Magliano PhD, D.W. Dunstan PhD, A.J. Cameron MPH, T. Dwyer MD, H.R. Taylor MD, A.M. Tonkin MD, T.Y. Wong PhD, J. McNeil PhD, and J.E. Shaw MD