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Relation between blood glucose and coronary mortality over 33 years in the Whitehall Study

Brunner, E.J.; Shipley, M.J.; Witte, D.R.; Fuller, J.H.; Marmot, M.G.; (2006) Relation between blood glucose and coronary mortality over 33 years in the Whitehall Study. Diabetes Care , 29 (1) pp. 26-31. 10.2337/diacare.29.01.06.dc05-1405.

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Abstract

Objective: Glucose intolerance is a risk factor for coronary disease, but there is uncertainty about the shape of the dose-response relationship between glucose level and risk of coronary mortality. We examined the prospective relation of 2-h postload blood glucose (2hBG) with coronary and other major causes of mortality over 33 years. Research Design and Methods:A 50-g oral glucose tolerance test (OGTT) was performed at baseline (1967–1969) in 17,869 male civil servants aged 40–64 years. Results: There were 3,561 coronary deaths during 451,787 person-years of observation. All-cause, cardiovascular, and respiratory mortality were elevated among participants with glucose intolerance. The hazard of coronary mortality rose from 2hBG = 4.6 mmol/l (83 mg/dl [95% CI 4.2–5.3]). The dose-response relation was best fitted by a single slope above this level, with no evidence of nonlinearity, compared with Cox models using other threshold levels, and those containing log 2hBG terms. There was no evidence for a dose-response relationship below 2hBG = 4.6 mmol/l. Between this level and 11.1 mmol/l (200 mg/dl), the age-adjusted hazard ratio was 3.62 (95% CI 2.3–5.6). The graded relationship was attenuated by 45% after adjustment for baseline coronary heart disease (CHD), BMI, systolic blood pressure, blood cholesterol, smoking, physical activity, lung function, and employment grade. Conclusions: A threshold model with linear slope best described the dose-response relationship between postload blood glucose and CHD mortality risk.

Type: Article
Title: Relation between blood glucose and coronary mortality over 33 years in the Whitehall Study
DOI: 10.2337/diacare.29.01.06.dc05-1405
Publisher version: http://dx.doi.org/10.2337/diacare.29.01.06.dc05-14...
Language: English
UCL classification: UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Epidemiology and Health > Epidemiology and Public Health
URI: http://discovery.ucl.ac.uk/id/eprint/6554
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