High Blood Glucose Concentration Is a Risk Factor for Mortality in Middle-Aged Nondiabetic Men: 20-year follow-up in the Whitehall Study, the Paris Prospective Study, and the Helsinki Policemen Study
- Beverley Balkau, PHD,
- Martin Shipley, MSC,
- R John Jarrett, MD,
- Kalevi Pyörälä, MD,
- Marja Pyörälä, MD,
- Anne Forhan, BSC and
- Eveline Eschwège, MD
- INSERM U21 and the Faculty of Medicine Paris-Sud Villejuif, France
- Department of Medicine, University of Kuopio Kuopio, Finland
- Department of Epidemiology and Public Health, University College Medical School London, U.K.
- Department of Public Health Medicine, United Medical and Dental Schools of Guy's and St. Thomas' Hospitals London, U.K.
- Address correspondence and reprint requests to Beverley Balkau, PhD, INSERM U21, 16 avenue Paul Vaillant Couturier, F-94807 Villejuif Cedex, France. E-mail:
OBJECTIVE To assess the association between high but nondiabetic blood glucose levels and the risk of death from all causes, coronary heart disease (CHD), cardiovascular disease, and neoplasms.
RESEARCH DESIGN AND METHODS We studied the 20-year mortality of non-diabetic, working men, age 44–55 years, in three European cohorts known as the Whitehall Study (n = 10,025), the Paris Prospective Study (n = 6,629), and the Helsinki Policeman Study (n = 631). These men were identified by their 2-h glucose levels following an oral glucose tolerance test and by the absence of a prior diagnosis of diabetes. As the protocol for the oral glucose tolerance test and methods for measuring glucose differed between studies, mortality was analyzed according to the percentiles of the 2-h and fasting glucose distributions, using the Cox's proportional hazards model.
RESULTS Men in the upper 20% of the 2-h glucose distributions and those in the upper 2.5% for fasting glucose had a significantly higher risk of all-cause mortality in comparison with men in the lower 80% of these distributions, with age-adjusted hazard ratios of 1.6 (95% CI 1.4–1.9) and 2.0 (1.6–2.6) for the upper 2.5%. For death from cardiovascular and CHD, men in the upper 2.5% of the 2-h and fasting glucose distributions were at higher risk, with age-adjusted hazard ratios for CHD of 1.8 (1.4–2.4) and 2.7 (1.7–4.4), respectively.
CONCLUSIONS If early intervention aimed at lowering blood glucose concentrations can be shown to reduce mortality, it may be justified to lower the levels of both 2-h and fasting glucose, which define diabetes.
- Received August 18, 1997.
- Accepted October 22, 1997.
- Copyright © 1998 by the American Diabetes Association