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OBJECTIVE - We investigated stroke mortality in individuals in different categories of glycemia and compared hazard ratios (HRs) corresponding to a 1-SD increase in 2-h plasma glucose and fasting plasma glucose (FPG) criteria.
RESEARCH DESIGN AND METHODS - We examined data from 2-h 75-g oral glucose tolerance tests taken from 13 European cohorts comprising 11,844 (55%) men and 9,862 (45%) women who were followed up for a median of 10.5 years. A multivariate adjusted Cox proportional hazards model was used to estimate HRs for stroke mortality.
RESULTS - In men and women without a prior history of diabetes, multivariate adjusted HRs for stroke mortality corresponding to a 1-SD increase in FPG were 1.02 (95% CI 0.83-1.25) and 1.52 (1.22-1.88) and those in 2-h plasma glucose 1.21 (1.06-1.38) and 1.31 (1.06-1.61), respectively. Addition of 2-h plasma glucose to the model with FPG significantly improved prediction of stroke mortality in men (χ^sup 2^ = 10.12; P = 0.001) but not in women (χ^sup 2^ = 0.01; P = 0.94), whereas addition of FPG to 2-h plasma glucose improved stroke mortality in women (χ^sup 2^ = 4.08; P = 0.04) but not in men (χ^sup 2^ = 3.29; P = 0.07).
CONCLUSIONS - Diabetes defined by either FPG or 2-h plasma glucose increases the risk of stroke mortality. In individuals without a history of diabetes, elevated 2-h postchallenge glucose is a better predictor than elevated fasting glucose in men, whereas the latter is better than the former in women.
Diabetes Care 32:348-354, 2009
Several epidemiological studies have indicated that diabetes is a major risk factor for stroke (1) and stroke recurrence (2). Some studies have also found an increased incidence of stroke with elevated blood glucose levels in non- diabetic individuals (3,4). Yet, not all studies have confirmed these findings (5,6) or have found a similar association only in women (7). Recently, a systematic overview of epidemiological studies and surveys from 52 countries found that 13% of stroke mortality cases were associated with elevated blood glucose levels mea- sured by fasting plasma glucose (FPG) levels (4). The association between hyper- glycemia and stroke events is, however, not as unequivocally described as that be- tween hyperglycemia and coronary heart disease (CHD). The Diabetes Epidemiology: Collaborative analysis Of Diagnostic...