Increased glucose levels in middle-aged adults that include the development of diabetes are associated with a higher risk for cardiovascular disease (CVD) compared with maintained or increased glucose levels below the diabetes threshold, report the results of a study published in Diabetes Care.

CVD is a leading cause of mortality and morbidity for persons with diabetes. Approximately one-third of adults in the United States have prediabetes (also associated with higher relative CVD risks), and therefore it is important from a public health standpoint to understand the absolute risk for CVD in this population. In this study, researchers estimated the long-term absolute risk for CVD according to fasting glucose levels that fell below the threshold of diabetes. Data were pooled from 7 observational cohorts of 19,630 individuals living in the United States who had not had a prior CVD event. 

Individuals were followed from 1960 to 2015 and fasting glucose was categorized as follows: <5.0 mmol/L, 5.0 to 5.5 mmol/L, 5.6 to 6.2 mmol/L, 6.3 to 6.9 mmol/L, and diabetes (fasting glucose ≥7.0 mmol/L or use of diabetes medications). The risk for CVD by fasting glucose category was measured at index age 55 years, and the risk for incident CVD according to change in fasting glucose before age 50 years was also assessed, specifically among the categories <5.6 mmol/L, 5.6 to 6.9 mmol/L, and diabetes.

The risk for CVD through 85 years of age varied from 15.3% (<5.0 mmol/L) to 38.6% (diabetes levels) among women, and from 21.5% (5.0 to 5.5 mmol/L) to 47.7% (diabetes levels) for men. Fasting glucose of 6.3 to 6.9 mmol/L was associated with greater long-term risks for CVD vs the lowest fasting glucose category in male participants, but this was not observed in women.

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Increased glucose level at the midlife point with conversion to diabetes was associated with a 1.3- to 3.6-fold increased CVD risk as opposed to increasing glucose that remained below the diabetes threshold.

“These data strongly support the monitoring of glucose levels during middle age and the importance of public health and clinical strategies that target prevention of incident diabetes by midlife,” wrote the researchers.

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Bancks MP, Ning H, Allen NB, et al. Long-term absolute risk for cardiovascular disease stratified by fasting glucose level [published online January 7, 2019]. Diabetes Care. doi:10.2337/dc18-1773