Hyperglycemia and stroke mortality -comparison between fasting and 2-hour glucose criteria
- Marjukka Hyvärinen, MSc (marjukka.hyvarinen{at}helsinki.fi)1,
- Qing Qiao, MD, PhD1,2,
- Jaakko Tuomilehto, MD, PhD1,2,
- Tiina Laatikainen, MD, PhD2,
- Robert J Heine, MD, PhD3,
- Coen DA Stehouwer, MD, PhD4,
- K George M M Alberti, MD, PhD5,
- Kalevi Pyörälä, MD, PhD6,
- Björn Zethelius, MD, PhD7 and
- Birgitta Stegmayr, MD, PhD8 for the DECODE Study Group
- 1. Department of Public Health, University of Helsinki, FIN-00014 Helsinki, Finland
- 2. Diabetes Unit, Department of Health Promotion and Chronic Disease Prevention, National Public Health Institute, FIN-00014 Helsinki, Finland
- 3. Institute for Research in Extramural Medicine, Vrije Universiteit Medical Center, 1081 BT Amsterdam, The Netherlands
- 4. Department of Medicine, University Hospital Maastricht, 6202 AZ Maastricht, The Netherlands
- 5. Imperial College, St Mary's Campus, 2nd Floor Mint Wing, St Mary's Hospital, London W2 1NY
- 6. Department of Medicine, University of Kuopio, FIN-70211 Kuopio, Finland
- 7. Department of Public Health/Geriatrics, Uppsala University Hospital, SE-751 85 Uppsala, Sweden
- 8. Department of Public Health and Clinical Medicine, University of Umeå, S-901 85 Umeå, Sweden
Abstract
Objective We investigated stroke mortality in individuals in different categories of glycemia and compared hazard ratios (HRs) corresponding to 1 SD increase in 2-h (2-h PG) and fasting plasma glucose (FPG) criteria.
Research Design and Methods Data from 13 European cohorts comprised 11844 (55%) men and 9862 (45%) women with a median follow-up of 10.5 years and 2-h 75-g oral glucose tolerance test. 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 (95% CIs) for stroke mortality corresponding to a one SD increase in FPG were 1.02 (0.83–1.25) and 1.52 (1.22–1.88) and those in 2-h PG 1.21 (1.06–1.38) and 1.31 (1.06–1.61), respectively. Addition of 2-h PG to the model with FPG significantly improved prediction of stroke mortality in men (Chi square = 10.12, p = 0.001) but not in women (Chi square = 0.01, p = 0.94), whereas addition of FPG with 2-h PG improved stroke mortality in women (Chi square = 4.08, p = 0.04), but not in men (Chi square = 3.29, p = 0.07).
Conclusions Diabetes defined by either FPG or 2-h PG increases the risk of stroke mortality. In individuals without a history of diabetes elevated 2-h post-challenge glucose is a better predictor than elevated fasting glucose in men, whereas the latter is better than the former in women.
Footnotes
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- Received August 6, 2008.
- Accepted November 7, 2008.
- Copyright © American Diabetes Association
