One-hour glucose value as a long-term predictor of cardiovascular morbidity and mortality: the Malmö Preventive Project

• Published in: European journal of endocrinology Vol. 178; no. 3; pp. 225 - 236
• Main Authors: Nielsen, Mette L, Pareek, Manan, Leósdóttir, Margrét, Eriksson, Karl-Fredrik, Nilsson, Peter M, Olsen, Michael H
• Format: Journal Article
• Language: English
• Published: England Bioscientifica Ltd 01.03.2018; Oxford University Press
• Subjects: Aged; Blood Glucose - metabolism; Cardiology and Cardiovascular Disease; Cardiovascular diseases; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - metabolism; Cardiovascular Diseases - mortality; Clinical Medicine; Clinical Study; Cohort Studies; Death; Diabetes; Diabetes mellitus; Endocrinology and Diabetes; Endokrinologi och diabetes; Glucose; Glucose Tolerance Test; Health risk assessment; Humans; Kardiologi och kardiovaskulära sjukdomar; Klinisk medicin; Male; Medical and Health Sciences; Medicin och hälsovetenskap; Middle Aged; Morbidity; Mortality; Population studies; Prognosis; Proportional Hazards Models; Prospective Studies; Risk Assessment; Risk factors; Sweden - epidemiology
• ISSN: 0804-4643; 1479-683X; 1479-683X
• DOI: 10.1530/EJE-17-0824

Objective To examine the predictive capability of a 1-h vs 2-h postload glucose value for cardiovascular morbidity and mortality. Design Prospective, population-based cohort study (Malmö Preventive Project) with subject inclusion 1974–1992. Methods 4934 men without known diabetes and cardiovascular disease, who had blood glucose (BG) measured at 0, 20, 40, 60, 90 and 120 min during an OGTT (30 g glucose per m2 body surface area), were followed for 27 years. Data on cardiovascular events and death were obtained through national and local registries. Predictive capabilities of fasting BG (FBG) and glucose values obtained during OGTT alone and added to a clinical prediction model comprising traditional cardiovascular risk factors were assessed using Harrell’s concordance index (C-index) and integrated discrimination improvement (IDI). Results Median age was 48 (25th–75th percentile: 48–49) years and mean FBG 4.6 ± 0.6 mmol/L. FBG and 2-h postload BG did not independently predict cardiovascular events or death. Conversely, 1-h postload BG predicted cardiovascular morbidity and mortality and remained an independent predictor of cardiovascular death (HR: 1.09, 95% CI: 1.01–1.17, P = 0.02) and all-cause mortality (HR: 1.10, 95% CI: 1.05–1.16, P < 0.0001) after adjusting for various traditional risk factors. Clinical risk factors with added 1-h postload BG performed better than clinical risk factors alone, in predicting cardiovascular death (likelihood-ratio test, P = 0.02) and all-cause mortality (likelihood-ratio test, P = 0.0001; significant IDI, P = 0.0003). Conclusion Among men without known diabetes, addition of 1-h BG, but not FBG or 2-h BG, to clinical risk factors provided incremental prognostic yield for prediction of cardiovascular death and all-cause mortality.