Even in the Range of Nondiabetic Fasting Blood Glucose Levels, There Is an Increasing Risk of CHD as the Glucose Level Increases

There is a correlation between rising blood glucose levels and increased risk of coronary heart disease (CHD), even in Non Diabetics.

Researchers at the Preventive Cardiology & Rehabilitation Department of the Cleveland Clinic Foundation have concluded that there is a correlation between rising blood glucose levels and increased risk of coronary heart disease (CHD). Investigators analyzed data for the first 2,440 high-risk patients without diabetes seen in their multidisciplinary cardiology prevention clinic between January 1996 and February 2001. The study examined relationships between the level of nondiabetic blood sugar concentration, the burden of traditional and nontraditional CHD risk factors, and the risk of CHD independent of these risk factors. Among the traditional CHD risk factors considered were age, smoking, body mass index (BMI), central obesity, hypertension, and dyslipidemia. The nontraditional risk factors considered included fibrinogen, homocysteine, and lipoprotein(a) [Lp(a)].

The patients (66% of whom were male) had dyslipidemia and/or hypertension and a fasting glucose concentration <125 mg/dL (mean 89 ± 13 mg/dL; range 37 to 125 mg/dL) and had been referred to the clinic for primary and secondary CHD prevention.

Fasting glucose quintiles were ≤79, 80–86, 87–92, 93–99, and 100–125 mg/dL. Increasing glucose quintiles were found to correlate directly with age (r=0.16), BMI (r=0.13), systolic BP (r=0.15), HDL cholesterol (r=-0.14), Framingham global risk score (r=0.16), fibrinogen (r=0.13), and homocysteine (r=0.08), and inversely with smoking (r=0.05) and Lp(a) (r=-0.07). P values ranged from 0.02 to <0.001.

The prevalence of CHD — defined on the basis of a documented myocardial infarction, >50% stenosis of ≥1 major coronary arteries, history of CABG, angioplasty, or stent, and/or CHD demonstrated by stress echocardiography, stress thallium scanning, or positron emission testing — increased progressively for both sexes with increasing blood glucose quintile (P>0.001), ranging in the whole group from 43% in the lowest quintile to 65% in the highest quintile. The odds ratio (highest to lowest quintile) for CHD was 2.5.

After adjusting for Framingham risk score (an algorithm of known CHD risk factors used to calculate the odds of developing the disease) and BMI alone, or for Framingham risk score, BMI, fibrinogen, Lp(a), and homocysteine, patients in the highest three quintiles of blood glucose continued to have a statistically significant increased likelihood of CHD. Adjustments for CHD related medications (e.g. aspirin, statins, etc.) did not diminish the relative risks ascribed to glucose.

Investigators concluded that there is a continuous relation between glucose level and CHD risk across the range of nondiabetic glucose levels, independent of traditional and nontraditional risk factors, and that this relationship is similar for men and women. Am J Cardiol. 2002;89:596-599.

FACT

Researchers uncovered the same trend in risk of stroke. Undiagnosed diabetics had more than twice the risk of stroke as those who were never diagnosed with the disease.  "So even before people develop diabetes, their heart disease risk is already elevated.  Diabetes Care 2002;25:1129-1134, 1142-1148.