·     Nielson C, Lange T, Hadjokas N.

University of Nevada Reno School of Medicine, Reno, Nevada, USA. cnielson@med.unr.edu

OBJECTIVE: Nondiabetic patients were studied to determine whether modest elevations in blood glucose may be associated with a greater incidence of coronary artery disease (CAD). RESEARCH DESIGN AND METHODS: Baseline morning blood glucose determinations were evaluated with respect to subsequent coronary disease using records from 24,160 nondiabetic patients. CAD was identified from myocardial infarction, new diagnoses of angina, or new prescriptions for nitroglycerin that occurred more than a year after baseline glucose determinations. RESULTS: Of 24,160 patients studied, 3,282 patients developed CAD over a total analysis time at risk of 77,048 years. Higher baseline morning glucose (100-126 vs. <100 mg/dl) was associated with a 53.9% greater myocardial infarction incidence rate, an 18.6% greater acute coronary syndrome incidence rate, and a 26.4% greater number of new prescriptions for nitrates (all P < 0.05). A Cox proportional hazards model with adjustment for age, BMI, sex, creatinine, lipids, smoking, and medications showed that elevated fasting glucose was associated with an increased hazard for new CAD (hazard ratio 1.13 [95% CI 1.05-1.21], glucose >100 vs. <100 mg/dl). Kaplan-Meier analysis showed that elevated baseline glucose was associated with a progressive increase risk of CAD with time. CONCLUSIONS: Patients with higher baseline blood glucose levels in the absence of diabetes and after adjustment for covariants have a significantly greater risk for development of CAD.

PMID: 16644627 [PubMed - indexed for MEDLINE]

·     Booth GL, Kapral MK, Fung K, Tu JV.

Department of Medicine, University of Toronto, Toronto, Ontario, Canada. boothg@smh.toronto.on.ca

BACKGROUND: Adults with diabetes are thought to have a high risk of cardiovascular disease (CVD), irrespective of their age. The main aim of this study was to find out the age at which people with diabetes develop a high risk of CVD, as defined by: an event rate equivalent to a 10-year risk of 20% or more; or an event rate equivalent to that associated with previous myocardial infarction. METHODS: We did a population-based retrospective cohort study using provincial health claims to identify all adults with (n=379,003) and (n=9,018,082) without diabetes mellitus living in Ontario, Canada, on April 1, 1994. Individuals were followed up to record CVD events until March 31, 2000. FINDINGS: The transition to a high-risk category occurred at a younger age for men and women with diabetes than for those without diabetes (mean difference 14.6 years). For the outcome of acute myocardial infarction (AMI), stroke, or death from any cause, diabetic men and women entered the high-risk category at ages 47.9 and 54.3 years respectively. When we used a broader definition of CVD that also included coronary or carotid revascularisation, the ages were 41.3 and 47.7 years for men and women with diabetes respectively. INTERPRETATION: Diabetes confers an equivalent risk to ageing 15 years. However, in general, younger people with diabetes (age 40 or younger) do not seem to be at high risk of CVD. Age should be taken into account in targeting of risk reduction in people with diabetes.

PMID: 16815377 [PubMed - indexed for MEDLINE]