A prospective study of low fasting glucose with cardiovascular disease events and all-cause mortality

The Women's Health Initiative

Morgana Mongraw-Chaffin, Andrea Z. LaCroix, Dorothy D. Sears, Lorena Garcia, Lawrence S. Phillips, Elena Salmoirago-Blotcher, Oleg Zaslavsky, Cheryl A M Anderson

Research output: Contribution to journalArticle

Abstract

Background While there is increasing recognition of the risks associated with hypoglycemia in patients with diabetes, few studies have investigated incident cause-specific cardiovascular outcomes with regard to low fasting glucose in the general population. Objective We hypothesized that low fasting glucose would be associated with cardiovascular disease risk and all-cause mortality in postmenopausal women. Methods To test our hypothesis, we used both continuous incidence rates and Cox proportional hazards models in 17,287 participants from the Women's Health Initiative with fasting glucose measured at baseline. Participants were separated into groups based on fasting glucose level: low (< 80 mg/dL), normal/reference (80–99 mg/dL), impaired (100–125 mg/dL), and diabetic (≥ 126 mg/dL). Results Participants were free of cardiovascular disease at enrollment, had mean age of 62 years, and were 52% Caucasian, 24% African American, 8% Asian, and 12% Hispanic. Median follow-up was 15 years. Graphs of continuous incidence rates compared to fasting glucose distribution exhibited evidence of a weak J-shaped association with heart failure and mortality that was predominantly due to participants with treated diabetes. Impaired and diabetic fasting glucose were positively associated with all outcomes. Associations for low fasting glucose differed, with coronary heart disease (HR = 0.64 (0.42, 0.98)) significantly inverse; stroke (0.73 (0.48, 1.13)), combined cardiovascular disease (0.91 (0.73, 1.14)), and all-cause mortality (0.97 (0.79, 1.20)) null or inverse and not significant; and heart failure (1.27 (0.80, 2.02)) positive and not significant. Conclusions Fasting glucose at the upper range, but not the lower range, was significantly associated with incident cardiovascular disease and all-cause mortality.

Original languageEnglish (US)
Pages (from-to)116-124
Number of pages9
JournalMetabolism: Clinical and Experimental
Volume70
DOIs
StatePublished - May 1 2017

Fingerprint

Women's Health
Fasting
Cardiovascular Diseases
Prospective Studies
Glucose
Mortality
Heart Failure
Incidence
Hispanic Americans
Proportional Hazards Models
Hypoglycemia
African Americans
Coronary Disease
Stroke
Population

Keywords

  • Cardiovascular disease
  • Epidemiology
  • Fasting glucose
  • Heart failure

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Mongraw-Chaffin, M., LaCroix, A. Z., Sears, D. D., Garcia, L., Phillips, L. S., Salmoirago-Blotcher, E., ... Anderson, C. A. M. (2017). A prospective study of low fasting glucose with cardiovascular disease events and all-cause mortality: The Women's Health Initiative. Metabolism: Clinical and Experimental, 70, 116-124. https://doi.org/10.1016/j.metabol.2017.02.010

A prospective study of low fasting glucose with cardiovascular disease events and all-cause mortality : The Women's Health Initiative. / Mongraw-Chaffin, Morgana; LaCroix, Andrea Z.; Sears, Dorothy D.; Garcia, Lorena; Phillips, Lawrence S.; Salmoirago-Blotcher, Elena; Zaslavsky, Oleg; Anderson, Cheryl A M.

In: Metabolism: Clinical and Experimental, Vol. 70, 01.05.2017, p. 116-124.

Research output: Contribution to journalArticle

Mongraw-Chaffin, M, LaCroix, AZ, Sears, DD, Garcia, L, Phillips, LS, Salmoirago-Blotcher, E, Zaslavsky, O & Anderson, CAM 2017, 'A prospective study of low fasting glucose with cardiovascular disease events and all-cause mortality: The Women's Health Initiative', Metabolism: Clinical and Experimental, vol. 70, pp. 116-124. https://doi.org/10.1016/j.metabol.2017.02.010
Mongraw-Chaffin, Morgana ; LaCroix, Andrea Z. ; Sears, Dorothy D. ; Garcia, Lorena ; Phillips, Lawrence S. ; Salmoirago-Blotcher, Elena ; Zaslavsky, Oleg ; Anderson, Cheryl A M. / A prospective study of low fasting glucose with cardiovascular disease events and all-cause mortality : The Women's Health Initiative. In: Metabolism: Clinical and Experimental. 2017 ; Vol. 70. pp. 116-124.
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AU - Mongraw-Chaffin, Morgana

AU - LaCroix, Andrea Z.

AU - Sears, Dorothy D.

AU - Garcia, Lorena

AU - Phillips, Lawrence S.

AU - Salmoirago-Blotcher, Elena

AU - Zaslavsky, Oleg

AU - Anderson, Cheryl A M

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N2 - Background While there is increasing recognition of the risks associated with hypoglycemia in patients with diabetes, few studies have investigated incident cause-specific cardiovascular outcomes with regard to low fasting glucose in the general population. Objective We hypothesized that low fasting glucose would be associated with cardiovascular disease risk and all-cause mortality in postmenopausal women. Methods To test our hypothesis, we used both continuous incidence rates and Cox proportional hazards models in 17,287 participants from the Women's Health Initiative with fasting glucose measured at baseline. Participants were separated into groups based on fasting glucose level: low (< 80 mg/dL), normal/reference (80–99 mg/dL), impaired (100–125 mg/dL), and diabetic (≥ 126 mg/dL). Results Participants were free of cardiovascular disease at enrollment, had mean age of 62 years, and were 52% Caucasian, 24% African American, 8% Asian, and 12% Hispanic. Median follow-up was 15 years. Graphs of continuous incidence rates compared to fasting glucose distribution exhibited evidence of a weak J-shaped association with heart failure and mortality that was predominantly due to participants with treated diabetes. Impaired and diabetic fasting glucose were positively associated with all outcomes. Associations for low fasting glucose differed, with coronary heart disease (HR = 0.64 (0.42, 0.98)) significantly inverse; stroke (0.73 (0.48, 1.13)), combined cardiovascular disease (0.91 (0.73, 1.14)), and all-cause mortality (0.97 (0.79, 1.20)) null or inverse and not significant; and heart failure (1.27 (0.80, 2.02)) positive and not significant. Conclusions Fasting glucose at the upper range, but not the lower range, was significantly associated with incident cardiovascular disease and all-cause mortality.

AB - Background While there is increasing recognition of the risks associated with hypoglycemia in patients with diabetes, few studies have investigated incident cause-specific cardiovascular outcomes with regard to low fasting glucose in the general population. Objective We hypothesized that low fasting glucose would be associated with cardiovascular disease risk and all-cause mortality in postmenopausal women. Methods To test our hypothesis, we used both continuous incidence rates and Cox proportional hazards models in 17,287 participants from the Women's Health Initiative with fasting glucose measured at baseline. Participants were separated into groups based on fasting glucose level: low (< 80 mg/dL), normal/reference (80–99 mg/dL), impaired (100–125 mg/dL), and diabetic (≥ 126 mg/dL). Results Participants were free of cardiovascular disease at enrollment, had mean age of 62 years, and were 52% Caucasian, 24% African American, 8% Asian, and 12% Hispanic. Median follow-up was 15 years. Graphs of continuous incidence rates compared to fasting glucose distribution exhibited evidence of a weak J-shaped association with heart failure and mortality that was predominantly due to participants with treated diabetes. Impaired and diabetic fasting glucose were positively associated with all outcomes. Associations for low fasting glucose differed, with coronary heart disease (HR = 0.64 (0.42, 0.98)) significantly inverse; stroke (0.73 (0.48, 1.13)), combined cardiovascular disease (0.91 (0.73, 1.14)), and all-cause mortality (0.97 (0.79, 1.20)) null or inverse and not significant; and heart failure (1.27 (0.80, 2.02)) positive and not significant. Conclusions Fasting glucose at the upper range, but not the lower range, was significantly associated with incident cardiovascular disease and all-cause mortality.

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