ISOLATED POSTCHALLENGE HYPERGLYCEMIA AND THE RISK OF FATAL CARDIOVASCULAR-DISEASE IN OLDER WOMEN AND MEN - THE RANCHO BERNARDO STUDY

OBJECTIVE - To determine whether diabetes defined by isolated postchal lenge hyperglycemia (IPH) (2-h postchallenge plasma glucose greater th an or equal to 11.1 mmol/l with lasting plasma glucose [FPG] <7.0 mmol /l) increases the risk of fatal cardiovascular disease (CVD) in older women and men. RESEARCH DESIGN AND METHODS - In a prospective study, w e followed 769 men and 1,089 women, aged 50-89 years, who had no histo ry of diabetes or myocardial infarction and demonstrated no lasting hy perglycemia (i.e., FPG <7.0 mmol/l) when they underwent oral glucose t olerance testing at baseline in 1984-1987, RESULTS - At baseline, 70% of 125 women and 48% of 133 men with previously undiagnosed diabetes h ad IPH. Over the next 7 years, women with IPH had a significantly incr eased risk of fatal CVD and heart disease compared with nondiabetic wo men. This increased risk was not observed in men with IPH. This associ ation was independent oi age, hypertension, central obesity, cigarette smoking, HDL cholesterol, and triglycerides (multiply adjusted hazard ratio and 95% CI: 2.6 and 1.4-4.7 for CVD; 2.9 and 1.3-6.4 for heart disease). CONCLUSIONS - Diabetes defined by IPH alone is common in old er adults and more than doubles the risk of fatal CVD and heart diseas e in older women. Because the prevalence of IPH increases with age, th e use of fasting glucose alone for diabetes screening or diagnosis may fail to identify most older adults at high risk for CVD and should be reevaluated.