ASYMPTOMATIC HYPERGLYCEMIA AND MAJOR ISCHEMIC-HEART-DISEASE EVENTS INBRITAIN

Objective - To examine the association between non-fasting serum gluco se concentrations and major ischaemic heart disease (II-ID) events (fa tal and non-fatal myocardial infarction). Design - A prospective study . Subjects - A population based sample of 7735 middle aged British men . Known diabetics, men with a glucose concentration greater than or eq ual to 11.1 mmol/l at screening, and hypertensive patients taking regu lar medication were excluded from the analysis. With exclusions (n = 5 09) and missing glucose values (n = 49), there were 7177 men available for analysis. Main outcome measures - Major IHD events (fatal and non -fatal myocardial infarction) during 9.5 years follow up on all men. R esults - There were 505 major IHD events, 222 fatal and 283 non-fatal, in the 7177 men studied. There was a non-linear relation between the glucose concentration and the risk (per 1000 men per year) of all majo r IHD events and fatal IHD events, with the excess risk in the upper q uintile of the glucose distribution (greater than or equal to 6.1 mmol /l). The unadjusted relative risks (RR) in the upper glucose concentra tion quintile compared with the first to the fourth quintiles combined were 1.4 (95% CI 1.1, 1.7) for all events and 1.3 (95% CI 1.0, 1.7) f or fatal events. Adjustment for age, smoking, occupational status, bod y mass index, physical activity, systolic blood pressure, total and hi gh density lipoprotein cholesterol, and triglyceride concentrations ha d a minimal effect on these relative risk estimates. This non-linear r elationship between the serum glucose concentration and the risk of a major IHD event was observed in men with no evidence of IHD at screeni ng (n = 5518) but not in men with IHD (n = 1659). In the former group, the RR (adjusted for major coronary risk factors) for all major IHD e vents in the upper quintile relative to the lower quintiles combined w as 1.5 (95% CI 1.2, 2.0) and for fatal IHD events was 1.8 (95% CI 1.1, 2.6). Conclusion - These data suggest that asymptomatic hyperglycaemi a is an independent risk factor for major IHD events.