Endocrinol Metab.  2021 Oct;36(5):1007-1015. 10.3803/EnM.2021.1218.

Frequency of Exposure to Impaired Fasting Glucose and Risk of Mortality and Cardiovascular Outcomes

• Lee SH
• Han K
• Kwon HS
• Kim MK

• KMID: 2521949
• DOI: http://doi.org/10.3803/EnM.2021.1218

Abstract

Background
Metabolic abnormalities, such as impaired fasting glucose (IFG), are dynamic phenomena; however, it is unclear whether the timing of IFG exposure and cumulative exposure to IFG are related to cardiovascular disease (CVD) and mortality risk.
Methods
Data were extracted from a nationwide population-based cohort in South Korea for adults (n=2,206,679) who were free of diabetes and had 4 years of consecutive health examination data. Fasting blood glucose levels of 100 to 125 mg/dL were defined as IFG, and the number of IFG diagnoses for each adult in the 4-year period was tabulated as the IFG exposure score (range, 0 to 4). Adults with persistent IFG for the 4-year period received a score of 4.
Results
The median follow-up was 8.2 years. There were 24,820 deaths, 13,502 cases of stroke, and 13,057 cases of myocardial infarction (MI). IFG exposure scores of 1, 2, 3, and 4 were associated with all-cause mortality (multivariable-adjusted hazard ratio [aHR], 1.11; 95% confidence interval [CI], 1.08 to 1.15; aHR, 1.16; 95% CI, 1.12 to 1.20; aHR, 1.20; 95% CI, 1.15 to 1.25; aHR, 1.18; 95% CI, 1.11 to 1.25, respectively) compared with an IFG exposure score of 0. Adjusting for hypertension and dyslipidemia attenuated the slightly increased risk of MI or stroke associated with high IFG exposure scores, but significant associations for allcause mortality remained.
Conclusion
The intensity of IFG exposure was associated with an elevated risk of all-cause mortality, independent of cardiovascular risk factors. The association between IFG exposure and CVD risk was largely mediated by the coexistence of dyslipidemia and hypertension.

Keyword

Prediabetic state; Blood glucose; Risk factors; Cardiovascular diseases

Figure

• 

  Fig. 1 Hazard ratios (HRs) and 95% confidence intervals (CIs) for (A) all-cause mortality, (B) myocardial infarction (MI), and (C) stroke according to baseline fasting blood glucose (FBG) levels. The reference group was defined as those with baseline FBG levels <80 mg/dL. The left-hand panel shows data adjusted for age, sex, alcohol consumption, smoking, physical activity, and body mass index (model 1). The right-hand panel presents data upon full adjustment for covariates including hypertension and dyslipidemia (model 2).

• 

  Fig. 2 Hazard ratios (HRs) and 95% confidence intervals (CIs) for (A) all-cause mortality, (B) myocardial infarction (MI), and (C) stroke according to impaired fasting glucose (IFG) exposure score. The group with an IFG exposure score of 0 was considered the reference group. The left-hand panel shows data adjusted for age, sex, alcohol consumption, smoking, physical activity, and body mass index (model 1). The right-hand panel presents data upon full adjustment for covariates including hypertension and dyslipidemia (model 2).

• 

  Fig. 3 Hazard ratios (HRs) and 95% confidence intervals (CIs) for (A) all-cause mortality, (B) myocardial infarction, and (C) stroke according to the severity-weighted impaired fasting glucose (IFG) exposure score ranging from 0 to 8. This IFG score was defined by assigning 0, 1, and 2 points to FBG levels of <100, 100–109, and 110–125 mg/dL, respectively. These scores were then summed to generate an IFG exposure score ranging from 0 to 8 points. A person with a score of 8 points corresponds to a person with a FBG ≥110 mg/dL at all annual health checkups over 4 years. The left-hand panel shows data adjusted for age, sex, alcohol consumption, smoking, physical activity, and body mass index (model 1). The right-hand panel presents data upon full adjustment for covariates including hypertension and dyslipidemia (model 2).

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