Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease

A collaborative meta-analysis of 102 prospective studies

The Emerging Risk Factors Collaboration

Research output: Contribution to journalArticle

Abstract

Background Uncertainties persist about the magnitude of associations of diabetes mellitus and fasting glucose concentration with risk of coronary heart disease and major stroke subtypes. We aimed to quantify these associations for a wide range of circumstances. Methods We undertook a meta-analysis of individual records of diabetes, fasting blood glucose concentration, and other risk factors in people without initial vascular disease from studies in the Emerging Risk Factors Collaboration. We combined within-study regressions that were adjusted for age, sex, smoking, systolic blood pressure, and bodymass index to calculate hazard ratios (HRs) for vascular disease. Findings Analyses included data for 698 782 people (52 765 non-fatal or fatal vascular outcomes; 8.49 million personyears at risk) from 102 prospective studies. Adjusted HRs with diabetes were: 2.00 (95% CI 1.83-2.19) for coronary heart disease; 2.27 (1.95-2.65) for ischaemic stroke; 1.56 (1.19-2.05) for haemorrhagic stroke; 1.84 (1.59-2.13) for unclassified stroke; and 1.73 (1.51-1.98) for the aggregate of other vascular deaths. HRs did not change appreciably after further adjustment for lipid, inflammatory, or renal markers. HRs for coronary heart disease were higher in women than in men, at 40-59 years than at 70 years and older, and with fatal than with non-fatal disease. At an adult population-wide prevalence of 10%, diabetes was estimated to account for 11% (10-12%) of vascular deaths. Fasting blood glucose concentration was non-linearly related to vascular risk, with no significant associations between 3.90 mmol/L and 5.59 mmol/L. Compared with fasting blood glucose concentrations of 3.90-5.59 mmol/L, HRs for coronary heart disease were: 1.07 (0.97-1.18) for lower than 3.90 mmol/L; 1.11 (1.04-1.18) for 5.60-6.09 mmol/L; and 1.17 (1.08-1.26) for 6.10-6.99 mmol/L. In people without a history of diabetes, information about fasting blood glucose concentration or impaired fasting glucose status did not significantly improve metrics of vascular disease prediction when added to information about several conventional risk factors. Interpretation Diabetes confers about a two-fold excess risk for a wide range of vascular diseases, independently from other conventional risk factors. In people without diabetes, fasting blood glucose concentration is modestly and nonlinearly associated with risk of vascular disease.

Original languageEnglish (US)
Pages (from-to)2215-2222
Number of pages8
JournalThe Lancet
Volume375
Issue number9733
DOIs
StatePublished - 2010

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Vascular Diseases
Blood Glucose
Meta-Analysis
Fasting
Diabetes Mellitus
Prospective Studies
Coronary Disease
Blood Vessels
Stroke
Blood Pressure
Glucose
Fatal Outcome
Uncertainty
Smoking
Kidney
Lipids
Population

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease : A collaborative meta-analysis of 102 prospective studies. / The Emerging Risk Factors Collaboration.

In: The Lancet, Vol. 375, No. 9733, 2010, p. 2215-2222.

Research output: Contribution to journalArticle

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abstract = "Background Uncertainties persist about the magnitude of associations of diabetes mellitus and fasting glucose concentration with risk of coronary heart disease and major stroke subtypes. We aimed to quantify these associations for a wide range of circumstances. Methods We undertook a meta-analysis of individual records of diabetes, fasting blood glucose concentration, and other risk factors in people without initial vascular disease from studies in the Emerging Risk Factors Collaboration. We combined within-study regressions that were adjusted for age, sex, smoking, systolic blood pressure, and bodymass index to calculate hazard ratios (HRs) for vascular disease. Findings Analyses included data for 698 782 people (52 765 non-fatal or fatal vascular outcomes; 8.49 million personyears at risk) from 102 prospective studies. Adjusted HRs with diabetes were: 2.00 (95{\%} CI 1.83-2.19) for coronary heart disease; 2.27 (1.95-2.65) for ischaemic stroke; 1.56 (1.19-2.05) for haemorrhagic stroke; 1.84 (1.59-2.13) for unclassified stroke; and 1.73 (1.51-1.98) for the aggregate of other vascular deaths. HRs did not change appreciably after further adjustment for lipid, inflammatory, or renal markers. HRs for coronary heart disease were higher in women than in men, at 40-59 years than at 70 years and older, and with fatal than with non-fatal disease. At an adult population-wide prevalence of 10{\%}, diabetes was estimated to account for 11{\%} (10-12{\%}) of vascular deaths. Fasting blood glucose concentration was non-linearly related to vascular risk, with no significant associations between 3.90 mmol/L and 5.59 mmol/L. Compared with fasting blood glucose concentrations of 3.90-5.59 mmol/L, HRs for coronary heart disease were: 1.07 (0.97-1.18) for lower than 3.90 mmol/L; 1.11 (1.04-1.18) for 5.60-6.09 mmol/L; and 1.17 (1.08-1.26) for 6.10-6.99 mmol/L. In people without a history of diabetes, information about fasting blood glucose concentration or impaired fasting glucose status did not significantly improve metrics of vascular disease prediction when added to information about several conventional risk factors. Interpretation Diabetes confers about a two-fold excess risk for a wide range of vascular diseases, independently from other conventional risk factors. In people without diabetes, fasting blood glucose concentration is modestly and nonlinearly associated with risk of vascular disease.",
author = "{The Emerging Risk Factors Collaboration} and N. Sarwar and P. Gao and {Kondapally Seshasai}, {S. R.} and R. Gobin and S. Kaptoge and {Di Angelantonio}, E. and E. Ingelsson and Lawlor, {D. A.} and Elizabeth Selvin and M. Stampfer and Stehouwer, {C. D A} and S. Lewington and L. Pennells and A. Thompson and N. Sattar and White, {I. R.} and Ray, {K. K.} and J. Danesh and Tipping, {R. W.} and Ford, {C. E.} and Pressel, {S. L.} and Folsom, {A. R.} and Chambless, {L. E.} and Wagenknecht, {L. E.} and Panagiotakos, {D. B.} and C. Pitsavos and C. Chrysohoou and C. Stefanadis and M. Knuiman and Whincup, {P. H.} and Wannamethee, {S. G.} and Morris, {R. W.} and S. Kiechl and J. Willeit and F. Oberhollenzer and A. Mayr and N. Wald and S. Ebrahim and Yarnell, {J. W.} and J. Gallacher and E. Casiglia and V. Tikhonoff and Nietert, {P. J.} and Sutherland, {S. E.} and Bachman, {D. L.} and Keil, {J. E.} and {de Boer}, {I. H.} and Kizer, {J. R.} and Mukamal, {K. J.} and A. Tybj{\ae}rg-Hansen",
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TY - JOUR

T1 - Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease

T2 - A collaborative meta-analysis of 102 prospective studies

AU - The Emerging Risk Factors Collaboration

AU - Sarwar, N.

AU - Gao, P.

AU - Kondapally Seshasai, S. R.

AU - Gobin, R.

AU - Kaptoge, S.

AU - Di Angelantonio, E.

AU - Ingelsson, E.

AU - Lawlor, D. A.

AU - Selvin, Elizabeth

AU - Stampfer, M.

AU - Stehouwer, C. D A

AU - Lewington, S.

AU - Pennells, L.

AU - Thompson, A.

AU - Sattar, N.

AU - White, I. R.

AU - Ray, K. K.

AU - Danesh, J.

AU - Tipping, R. W.

AU - Ford, C. E.

AU - Pressel, S. L.

AU - Folsom, A. R.

AU - Chambless, L. E.

AU - Wagenknecht, L. E.

AU - Panagiotakos, D. B.

AU - Pitsavos, C.

AU - Chrysohoou, C.

AU - Stefanadis, C.

AU - Knuiman, M.

AU - Whincup, P. H.

AU - Wannamethee, S. G.

AU - Morris, R. W.

AU - Kiechl, S.

AU - Willeit, J.

AU - Oberhollenzer, F.

AU - Mayr, A.

AU - Wald, N.

AU - Ebrahim, S.

AU - Yarnell, J. W.

AU - Gallacher, J.

AU - Casiglia, E.

AU - Tikhonoff, V.

AU - Nietert, P. J.

AU - Sutherland, S. E.

AU - Bachman, D. L.

AU - Keil, J. E.

AU - de Boer, I. H.

AU - Kizer, J. R.

AU - Mukamal, K. J.

AU - Tybjærg-Hansen, A.

PY - 2010

Y1 - 2010

N2 - Background Uncertainties persist about the magnitude of associations of diabetes mellitus and fasting glucose concentration with risk of coronary heart disease and major stroke subtypes. We aimed to quantify these associations for a wide range of circumstances. Methods We undertook a meta-analysis of individual records of diabetes, fasting blood glucose concentration, and other risk factors in people without initial vascular disease from studies in the Emerging Risk Factors Collaboration. We combined within-study regressions that were adjusted for age, sex, smoking, systolic blood pressure, and bodymass index to calculate hazard ratios (HRs) for vascular disease. Findings Analyses included data for 698 782 people (52 765 non-fatal or fatal vascular outcomes; 8.49 million personyears at risk) from 102 prospective studies. Adjusted HRs with diabetes were: 2.00 (95% CI 1.83-2.19) for coronary heart disease; 2.27 (1.95-2.65) for ischaemic stroke; 1.56 (1.19-2.05) for haemorrhagic stroke; 1.84 (1.59-2.13) for unclassified stroke; and 1.73 (1.51-1.98) for the aggregate of other vascular deaths. HRs did not change appreciably after further adjustment for lipid, inflammatory, or renal markers. HRs for coronary heart disease were higher in women than in men, at 40-59 years than at 70 years and older, and with fatal than with non-fatal disease. At an adult population-wide prevalence of 10%, diabetes was estimated to account for 11% (10-12%) of vascular deaths. Fasting blood glucose concentration was non-linearly related to vascular risk, with no significant associations between 3.90 mmol/L and 5.59 mmol/L. Compared with fasting blood glucose concentrations of 3.90-5.59 mmol/L, HRs for coronary heart disease were: 1.07 (0.97-1.18) for lower than 3.90 mmol/L; 1.11 (1.04-1.18) for 5.60-6.09 mmol/L; and 1.17 (1.08-1.26) for 6.10-6.99 mmol/L. In people without a history of diabetes, information about fasting blood glucose concentration or impaired fasting glucose status did not significantly improve metrics of vascular disease prediction when added to information about several conventional risk factors. Interpretation Diabetes confers about a two-fold excess risk for a wide range of vascular diseases, independently from other conventional risk factors. In people without diabetes, fasting blood glucose concentration is modestly and nonlinearly associated with risk of vascular disease.

AB - Background Uncertainties persist about the magnitude of associations of diabetes mellitus and fasting glucose concentration with risk of coronary heart disease and major stroke subtypes. We aimed to quantify these associations for a wide range of circumstances. Methods We undertook a meta-analysis of individual records of diabetes, fasting blood glucose concentration, and other risk factors in people without initial vascular disease from studies in the Emerging Risk Factors Collaboration. We combined within-study regressions that were adjusted for age, sex, smoking, systolic blood pressure, and bodymass index to calculate hazard ratios (HRs) for vascular disease. Findings Analyses included data for 698 782 people (52 765 non-fatal or fatal vascular outcomes; 8.49 million personyears at risk) from 102 prospective studies. Adjusted HRs with diabetes were: 2.00 (95% CI 1.83-2.19) for coronary heart disease; 2.27 (1.95-2.65) for ischaemic stroke; 1.56 (1.19-2.05) for haemorrhagic stroke; 1.84 (1.59-2.13) for unclassified stroke; and 1.73 (1.51-1.98) for the aggregate of other vascular deaths. HRs did not change appreciably after further adjustment for lipid, inflammatory, or renal markers. HRs for coronary heart disease were higher in women than in men, at 40-59 years than at 70 years and older, and with fatal than with non-fatal disease. At an adult population-wide prevalence of 10%, diabetes was estimated to account for 11% (10-12%) of vascular deaths. Fasting blood glucose concentration was non-linearly related to vascular risk, with no significant associations between 3.90 mmol/L and 5.59 mmol/L. Compared with fasting blood glucose concentrations of 3.90-5.59 mmol/L, HRs for coronary heart disease were: 1.07 (0.97-1.18) for lower than 3.90 mmol/L; 1.11 (1.04-1.18) for 5.60-6.09 mmol/L; and 1.17 (1.08-1.26) for 6.10-6.99 mmol/L. In people without a history of diabetes, information about fasting blood glucose concentration or impaired fasting glucose status did not significantly improve metrics of vascular disease prediction when added to information about several conventional risk factors. Interpretation Diabetes confers about a two-fold excess risk for a wide range of vascular diseases, independently from other conventional risk factors. In people without diabetes, fasting blood glucose concentration is modestly and nonlinearly associated with risk of vascular disease.

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