Hyperglycaemia is associated with all-cause and cardiovascular mortality in the Hoorn population: the Hoorn Study

Aims/hypothesis. The degree of glycaemia has been shown to be associated wi th all-cause and cardiovascular mortality in diabetic subjects. Whether thi s association also exists in the general population is still controversial. We studied the predictive value of fasting plasma glucose, 2-hour post-loa d glucose and HbA(1c) in a population-based cohort of 2363 older (50-75 yea rs) subjects, without known diabetes. Methods. Relative risks (RR) of all-cause and cardiovascular mortality were estimated by Cox proportional hazards model, adjusting for age and sex? an d additionally for known cardiovascular risk factors. Results. During 8 years of follow-up, 185 subjects died; 98 of cardiovascul ar causes. Fasting plasma glucose was only predictive in the diabetic range , although the risks started to increase at about 6.1 mmol/l. Postload gluc ose and HbA(1c) values were, even within the non-diabetic range, associated with an increased risk (p for linear trend < 0.05). These increased risks were mostly but not completely, attributable to known cardiovascular risk f actors. After exclusion of subjects with newly diagnosed diabetes or with p re-existent cardiovascular disease (n = 551), a 5.8mmol/l increase of post- load glucose (corresponding to two standard deviations of the population di stribution) was associated with a higher age-adjusted and sex-adjusted risk of all-cause (RR 2.24) and cardiovascular mortality (RR 3.40) (p < 0.05), After additional adjustment for known cardiovascular risk factors, these re lative risks mere still statistically significant, with values of 2.20 and 3.00 respectively (p < 0.05). Conclusions/interpretations. High glycaemic variables, especially 2-h post- load glucose concentrations and to a lesser extent HbA(1c) values, indicate a risk of all-cause and cardiovascular mortality in a general population w ithout known diabetes.