Hyperglycemia and Stroke Mortality

Comparison between fasting and 2-h glucose criteria

  1. Marjukka Hyvärinen, MSC1,
  2. Qing Qiao, MD, PHD12,
  3. Jaakko Tuomilehto, MD, PHD12,
  4. Tiina Laatikainen, MD, PHD2,
  5. Robert J. Heine, MD, PHD3,
  6. Coen D.A. Stehouwer, MD, PHD4,
  7. K. George M.M. Alberti, MD, PHD5,
  8. Kalevi Pyörälä, MD, PHD6,
  9. Björn Zethelius, MD, PHD7,
  10. Birgitta Stegmayr, MD, PHD8 and
  11. for the DECODE Study Group*
  1. 1Department of Public Health, University of Helsinki, Helsinki, Finland
  2. 2Diabetes Unit, Department of Health Promotion and Chronic Disease Prevention, National Public Health Institute, Helsinki, Finland
  3. 3Institute for Research in Extramural Medicine, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
  4. 4Department of Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
  5. 5Imperial College, St Mary's Campus, St Mary's Hospital, London, U.K.
  6. 6Department of Medicine, University of Kuopio, Kuopio, Finland
  7. 7Department of Public Health/Geriatrics, Uppsala University Hospital, Uppsala, Sweden
  8. 8Department of Public Health and Clinical Medicine, University of Umeå, Umeå, Sweden
  1. Corresponding author: Marjukka Hyvärinen, marjukka.hyvarinen{at}helsinki.fi

Abstract

OBJECTIVE—We investigated stroke mortality in individuals in different categories of glycemia and compared hazard ratios (HRs) corresponding to a 1-SD increase in 2-h plasma glucose and fasting plasma glucose (FPG) criteria.

RESEARCH DESIGN AND METHODS—We examined data from 2-h 75-g oral glucose tolerance tests taken from 13 European cohorts comprising 11,844 (55%) men and 9,862 (45%) women who were followed up for a median of 10.5 years. A multivariate adjusted Cox proportional hazards model was used to estimate HRs for stroke mortality.

RESULTS—In men and women without a prior history of diabetes, multivariate adjusted HRs for stroke mortality corresponding to a 1-SD increase in FPG were 1.02 (95% CI 0.83–1.25) and 1.52 (1.22–1.88) and those in 2-h plasma glucose 1.21 (1.06–1.38) and 1.31 (1.06–1.61), respectively. Addition of 2-h plasma glucose to the model with FPG significantly improved prediction of stroke mortality in men (χ2 = 10.12; P = 0.001) but not in women (χ2 = 0.01; P = 0.94), whereas addition of FPG to 2-h plasma glucose improved stroke mortality in women (χ2 = 4.08; P = 0.04) but not in men (χ2 = 3.29; P = 0.07).

CONCLUSIONS—Diabetes defined by either FPG or 2-h plasma glucose increases the risk of stroke mortality. In individuals without a history of diabetes, elevated 2-h postchallenge glucose is a better predictor than elevated fasting glucose in men, whereas the latter is better than the former in women.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 18 November 2008.

  • *

    ↵* A complete list of studies and investigators of the DECODE collaborative study can be found in an online appendix at http://dx.doi.org/10.2337/dc08-1411.

  • Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Accepted November 7, 2008.
    • Received August 6, 2008.
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  1. Published online before print November 18, 2008, doi: 10.2337/dc08-1411 Diabetes Care February 2009 vol. 32 no. 2 348-354
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