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J Gerontol A Biol Sci Med Sci. 2016 Mar;71(3):370-7. doi: 10.1093/gerona/glv106. Epub 2015 Aug 27.

Relations of Postload and Fasting Glucose With Incident Cardiovascular Disease and Mortality Late in Life: The Cardiovascular Health Study.

Author information

1
Albert Einstein College of Medicine, Department of Medicine, Bronx, NY 10461. Erika.brutsaert@einstein.yu.edu.
2
Albert Einstein College of Medicine, Department of Medicine, Bronx, NY 10461.
3
University of Washington, Department of Biostatistics, Seattle, WA 98115.
4
Beth Israel Deaconess Medical Center, Department of Medicine, Boston, MA 02215.
5
University of Washington, Department of Medicine, Seattle, WA 98195.
6
Brigham Young University, Department of Health Science, Provo, UT 84602.
7
Kaiser Permanente, Duluth GA 30496.
8
Brigham and Women's Hospital, Department of Medicine, Boston MA 02120.
9
University of California San Diego, School of Medicine, La Jolla, CA 92093.
10
University of Washington, Department of Epidemiology, Seattle, WA 98195. Cardiovascular Health Research Unit, Department of Medicine, Epidemiology of Health Sciences, University of Washington, Seattle WA; Group Health Research institute Group Health Cooperative Seattle WA 98101. Seattle Epidemiologic Research and Formation Center; VA office of Research and Development, Seattle WA 98101.
11
Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, NY 10461.
12
New York Academy of Medicine, New York, NY 10029.
13
University of Washington, Department of Epidemiology, Seattle, WA 98195. Cardiovascular Health Research Unit, Department of Medicine, Epidemiology of Health Sciences, University of Washington, Seattle WA; Group Health Research institute Group Health Cooperative Seattle WA 98101.
14
Albert Einstein College of Medicine, Department of Medicine, Bronx, NY 10461. Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, NY 10461.

Abstract

BACKGROUND:

Older adults have a high prevalence of postload hyperglycemia. Postload glucose has shown more robust associations with cardiovascular disease (CVD) and death than fasting glucose, but data in the oldest old are sparse.

METHODS:

Fasting and 2-hour postload glucose were measured in community-dwelling older adults, mean age 78, at the 1996-1997 follow-up visit of the Cardiovascular Health Study. We evaluated their associations with atherosclerotic CVD (ASCVD) and mortality using standard Cox regression and competing-risks analyses and assessed improvement in prediction-model discrimination with the c-statistic.

RESULTS:

Among 2,394 participants without treated diabetes and available data on glycemic measures, there were 579 ASCVD events and 1,698 deaths during median follow-up of 11.2 years. In fully adjusted models, both fasting and 2-hour glucose were associated with ASCVD (HR per SD, 1.13 [1.03-1.25] and 1.17 [1.07-1.28], respectively) and all-cause mortality (HR 1.12 [1.07-1.18] and 1.14 [1.08-1.20]). After mutual adjustment, however, the associations for fasting glucose with both outcomes were abolished, but those for postload glucose were largely unchanged. Consistent findings were observed for ASCVD in competing-risks models.

CONCLUSION:

In adults surviving to advanced old age, postload glucose was associated with ASCVD and mortality independently of fasting glucose, but fasting glucose was not associated with these outcomes independently of postload glucose. These findings affirm the robust association of postload glucose with ASCVD and death late in life.

KEYWORDS:

Cardiovascular; Diabetes; Epidemiology; Risk factors

PMID:
26314953
PMCID:
PMC5864159
DOI:
10.1093/gerona/glv106
[Indexed for MEDLINE]
Free PMC Article

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