Abstract

Objective — With increasing evidence about the cardiovascular (CV) risk associated with postprandial nonfasting glucose and lipid dysmetabolism, it remains uncertain whether postprandial glucose (PG) concentration increases the ability of metabolic syndrome (MetS) in predicting CV events.

Research Design and Methods — An observational study of 15,145 individuals 35 to 75 of age without diabetes or CV diseases. PG was obtained 2 hours after a lunch meal. MetS was diagnosed using the criteria of the US National Cholesterol Education Program's Adult Treatment Panel III. CV and all-cause death were primary outcomes.

Results — During a median follow-up of 6.7 years, 410 individuals died, including 82 deaths from CV causes. In a Cox model adjusting for MetS status as well as age, sex, smoking, systolic blood pressure, low-density-lipoprotein and high-density-lipoprotein cholesterols, elevated 2-hr PG increased the risk of CV and all-cause death (per mmol/l increase, hazard ratio [95% confidence interval], 1.26 [1.11 – 1.42] and 1.10 [1.04 – 1.16], respectively), with significant trends across the PG quintiles. Including 2-hr PG into a MetS-included multivariate risk prediction model conferred a discernible improvement of the model in discriminating between those who died of CV causes and who did not (integrated discrimination improvement, 0.4 %; p=0.005; net reclassification improvement, 13.4%, p=0.03); however, the improvement was only marginal for all-cause death.

Conclusions — Given the risk prediction based on MetS and established CV risk factors, 2-hr PG improves the predictive ability to identity non-diabetic individuals at increased risk of CV death.