Fasting plasma glucose and risk of incident ischemic stroke or transient ischemic attacks - A prospective cohort study
Fasting plasma glucose and risk of incident ischemic stroke or transient ischemic attacks - A prospective cohort study
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DOI：
10.1161/01.str.0000140738.94047.55
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发表时间：
2004-10-01
期刊：
影响因子：
8.3
通讯作者：
Goldbourt, U
中科院分区：
文献类型：
--
作者：
Tanne, D;Koren-Morag, N;Goldbourt, U
背景和目的——糖尿病和空腹血糖受损是根据隔夜禁食后血浆葡萄糖水平升高来诊断的。糖尿病的诊断切点源自微血管并发症发生的阈值。我们的目的是检查空腹血糖水平的临床相关类别与发生缺血性中风的风险之间的关联。方法-对经筛选纳入二级预防临床试验的患有冠心病的患者（n = 13 999）进行随访。在基线时，在中心研究实验室获取病史并评估血浆葡萄糖和血脂。在6至8年的随访期间，1037例被确诊为缺血性脑血管疾病，其中，在审查诊断为脑血管疾病的医院记录后，证实576例患有缺血性中风或短暂性脑缺血发作。 甘油三酯，并与高密度脂蛋白胆固醇和高密度脂蛋白占总胆固醇的百分比呈负相关。与构成最大类别的空腹血糖水平为 90 至 99 mg/dL (n = 3706) 的患者相比，调整潜在混杂因素后，空腹血糖为 140 mg/dL 时，缺血性脑血管疾病的优势比为 1.47（95% CI，1.07 至 2.02）。在排除已知糖尿病诊断的患者的分析中观察到类似的 J 形关联。结论 - 患有先前存在的动脉粥样硬化血栓性疾病的患者的空腹血糖与事件缺血性脑血管事件之间的关联是 J 形的。空腹血糖水平 > 100 mg/dL 以及空腹血糖水平较低的患者的发病率也会增加。这些发现可能对预防策略具有重要意义。
Background and Purpose-Diabetes and impaired fasting glucose are diagnosed based on an elevated plasma glucose level after an overnight fast. The diagnostic cutpoint of diabetes arises from the threshold for development of microvascular complications. Our aim was to examine the associations between clinical relevant categories of fasting glucose levels and the risk of incident ischemic stroke.Methods-Patients with documented coronary heart disease who were screened for inclusion in a secondary prevention clinical trial (n = 13 999) were followed-up. At baseline, medical histories were obtained and plasma glucose and lipids assessed at a central study laboratory. During a 6- to 8-year follow-up period 1037 cases were identified with ischemic cerebrovascular disease, of which, after reviewing hospital records with diagnoses of cerebrovascular disease, 576 cases were verified to have had ischemic stroke or transient ischemic attacks.Results-Increasing fasting glucose level categories were positively associated with increasing age, male gender, body mass index, hypertension, total cholesterol, and triglycerides, and were inversely associated with high-density lipoprotein cholesterol and percent high-density lipoprotein of total cholesterol. In comparison with patients with fasting glucose levels of 90 to 99 mg/dL (n = 3706) who constitute the largest category, the odds ratios of ischemic cerebrovascular disease, adjusting for potential confounders, were 1.47 (95% CI, 1.07 to 2.02) for fasting glucose 140 mg/dL. Similar J-shaped associations were observed in analysis excluding patients with known diagnosis of diabetes mellitus.Conclusions-The association between fasting plasma glucose and incident ischemic cerebrovascular events in patients with pre-existing atherothrombotic disease is J-shaped. Rates increase for fasting plasma glucose levels > 100 mg/dL and also for those with low fasting glucose levels. These findings may carry important implications for prevention strategies.