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Blood glucose and subsequent cardiovascular disease: update of a meta-analysis.
MedLine Citation:
PMID:  21973198     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Abstract Background/purpose: A 1999 meta-analysis described the relationship between blood glucose and subsequent cardiovascular events (MI, stroke, cardiovascular mortality). More studies have been published; therefore, we updated and refined estimates of this relationship in people without diabetes. Acceptability criteria: We accepted prospective studies that reported screening results for blood glucose levels (either fasting, 2-hour postprandial, 1-hour postprandial, or casual) divided into ≥3 quantiles. Required data within each quantile were numbers exposed plus study duration or person-years at risk, and numbers of cardiovascular outcomes (myocardial infarction, stroke, death). No restrictions were placed on language or publication date. Data sources: Two reviewers searched Medline, Embase, Scopus, and Cochrane databases from inception until December 2009. Consensus settled discrepancies. Data synthesis: Poisson regression quantified the relationship between glucose quantile and outcomes. Beta values were combined with inverse variance weightings using a random effects meta-analytic model. Results: We found 36 articles with 141 datasets examining the relationship between blood glucose (32 fasting, 52 2-hour postprandial, 37 1-hour postprandial, 20 casual) in 191,249 patients without diabetes (73% male) for 3 million person-years. There were 12,537 (6.6%) cardiovascular deaths, 14,445 (7.6%) cardiovascular events, 6862 (3.6%) cardiac and 3412 (1.7%) stroke deaths. Relative risks/unit increase in blood glucose were all significant for total cardiovascular events (RRs ranged from 1.09-1.51, all p-values < 0.005) and cardiovascular deaths (RR = 1.05-1.24, p < 0.007), and all for cardiac deaths (p < 0.05) except casual glucose; stroke mortality was less clear. The two strongest relationships were found between fasting levels and all events (RR = 1.51, CI: 1.20-1.89) and with cardiovascular mortality (RR = 1.40, CI: 1.18-1.60). With 2-hour postprandial levels, the respective RRs were 1.22 (1.17-1.28) and 1.24 (1.19-1.30). A limitation is the assumption of a continuous relationship between variables. Conclusions: We have provided refined estimates confirming the association between elevated blood glucose and subsequent cardiovascular events.
Authors:
Thomas R Einarson; Márcio Machado; Michiel Eric Henk Hemels
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-10-5
Journal Detail:
Title:  Current medical research and opinion     Volume:  -     ISSN:  1473-4877     ISO Abbreviation:  -     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-10-6     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0351014     Medline TA:  Curr Med Res Opin     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Leslie Dan Faculty of Pharmacy, University of Toronto , ON , Canada.
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