Continuous Relationships Between Non-Diabetic Hyperglycaemia and Both Cardiovascular Disease and All-Cause Mortality: The Australian Diabetes, Obesity, and Lifestyle (AusDiab) Study

Diabetologia. 2009 Mar;52(3):415-24. doi: 10.1007/s00125-008-1246-y. Epub 2009 Jan 8.

Abstract

Aims/hypothesis: Hyperglycaemia is a risk factor for cardiovascular disease (CVD) and all-cause mortality in individuals without diabetes. We investigated: (1) whether the risk of all-cause and CVD mortality extended continuously throughout the range of fasting plasma glucose (FPG), 2 h plasma glucose (2hPG) and HbA(1c) values; and (2) the ability of these measures to improve risk prediction for mortality.

Methods: Data on 10,026 people aged >or=25 years without diagnosed diabetes were obtained from the population-based Australian Diabetes, Obesity and Lifestyle study. Between 1999 and 2000, FPG, 2hPG and HbA(1c) were assessed and all-cause (332 deaths) and CVD (88 deaths) mortality were obtained after 7 years.

Results: Both 2hPG and HbA(1c) exhibited linear relationships with all-cause and CVD mortality, whereas FPG showed J-shaped relationships. The adjusted HR (95% CI) for all-cause mortality per SD increase was 1.2 (1.1-1.3) for 2hPG and 1.1 (1.0-1.2) for HbA(1c). The HR for FPG <5.1 mmol/l (per SD decrease) was 2.0 (1.3-3.0); for FPG >or=5.1 mmol/l (per SD increase) the HR was 1.1 (1.0-1.2). Corresponding HRs for CVD mortality were 1.2 (1.0-1.4), 1.2 (1.0-1.3), 4.0 (2.1-7.6) and 1.3 (1.1-1.4). The discriminative ability of each measure was similar; no measure substantially improved individual risk identification over traditional risk factors.

Conclusions/interpretation: In individuals without diagnosed diabetes, 2hPG and FPG, but not HbA(1c) were significant predictors of all-cause mortality, whereas all measures were significant predictors of CVD mortality. However, these glucose measures did not substantially improve individual risk identification.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Australia / epidemiology
  • Blood Glucose / metabolism
  • Blood Pressure
  • Cardiovascular Diseases / epidemiology*
  • Cardiovascular Diseases / mortality
  • Diabetes Mellitus / blood
  • Diabetes Mellitus / epidemiology*
  • Diabetes Mellitus / mortality
  • Female
  • Follow-Up Studies
  • Glycated Hemoglobin A / analysis
  • Heart Rate
  • Humans
  • Hyperglycemia / epidemiology*
  • Hyperglycemia / mortality
  • Life Style*
  • Male
  • Middle Aged
  • Obesity / epidemiology*
  • Obesity / mortality
  • Proportional Hazards Models
  • Triglycerides / blood
  • Waist-Hip Ratio

Substances

  • Blood Glucose
  • Glycated Hemoglobin A
  • Triglycerides