A prospective study of low fasting glucose with cardiovascular disease events and all-cause mortality: The Women's Health Initiative

• Type of Material: Article
• Authors: Morgana Mongraw-Chaffin, University of California San Diego; Andrea Z. LaCroix, University of California San Diego; Dorothy D. Sears, University of California San Diego; Lorena Garcia, University of California Davis; Lawrence S Phillips, Emory University; Elena Salmoirago-Blotcher, Brown University; Oleg Zaslausky, University of Washington; Cheryl A.M. Anderson, University of California San Diego
• Language: English
• Date: 2017-05-01
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 Elsevier Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1016/j.metabol.2017.02.010
• Title of Journal or Parent Work: Metabolism
• ISSN: 0026-0495
• Volume: 70
• Start Page: 116
• End Page: 124
• Grant/Funding Information: The WHI programs is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services through contracts, HHSN268201100046C, HHSN268201100001C, HHSN268201100002C, HHSN268201100003C, HHSN268201100004C LP was supported in part by FDA award RO1FD003527 (L.S.P), VA awards HSR&D IIR 07-138 (L.S.P and I01-CX001025 (L.S.P.), NIH awards R21DK099716 (L.S.P), DK066204 (L.S.P.), U01 DK091958 (L.S.P. U01 DK098246 (L.S.P.), and a Cystic Fibrosis Foundation award PHILLI12A0 (L.S.P).; MMC was supported by T32 training grants National Heart, Lung, and Blood Institute 5T32HL079891-06 and 5T32HL007261-34.; LP is also supported in part by the VA.
• Keywords: PLASMA-GLUCOSE; Cardiovascular disease; NONDIABETIC ADULTS; Life Sciences & Biomedicine; Endocrinology & Metabolism; HEMOGLOBIN A(1C); Heart failure; LEVEL; Epidemiology; Fasting glucose; RISK; Science & Technology
• Research Categories: Health Sciences, Nutrition; Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

Background While there is increasing recognition of the risks associated with hypoglycemia in patients with diabetes, few studies have investigated incident cause-specific cardiovascular outcomes with regard to low fasting glucose in the general population. Objective We hypothesized that low fasting glucose would be associated with cardiovascular disease risk and all-cause mortality in postmenopausal women. Methods To test our hypothesis, we used both continuous incidence rates and Cox proportional hazards models in 17,287 participants from the Women's Health Initiative with fasting glucose measured at baseline. Participants were separated into groups based on fasting glucose level: low ( <  80 mg/dL), normal/reference (80–99 mg/dL), impaired (100–125 mg/dL), and diabetic (≥ 126 mg/dL). Results Participants were free of cardiovascular disease at enrollment, had mean age of 62 years, and were 52% Caucasian, 24% African American, 8% Asian, and 12% Hispanic. Median follow-up was 15 years. Graphs of continuous incidence rates compared to fasting glucose distribution exhibited evidence of a weak J-shaped association with heart failure and mortality that was predominantly due to participants with treated diabetes. Impaired and diabetic fasting glucose were positively associated with all outcomes. Associations for low fasting glucose differed, with coronary heart disease (HR = 0.64 (0.42, 0.98)) significantly inverse; stroke (0.73 (0.48, 1.13)), combined cardiovascular disease (0.91 (0.73, 1.14)), and all-cause mortality (0.97 (0.79, 1.20)) null or inverse and not significant; and heart failure (1.27 (0.80, 2.02)) positive and not significant. Conclusions Fasting glucose at the upper range, but not the lower range, was significantly associated with incident cardiovascular disease and all-cause mortality.