A Cohort Study On Fasting Plasma Glucose And The Risk Of All-Cause And Cardiovascular Disease Mortality

ObjectivesTo evaluate the association between fasting plasma glucose?FPG?and all-cause and cardiovascular disease?CVD?mortality.MethodsCluster random sampling was used to recruit 20,194 participants?18 years old in Xin'an County,Henan Province,China during July to August of 2007 and July to August of 2008.Follow-up examination of 17,265 participants was performed between July to August of 2013 and July to October of 2014?response rate 85.5%?.The same questionnaire interview,anthropometric and laboratory measurements were performed at both baseline and follow-up.Participants were excluded from the current study if they had missing information for FPG at baseline?n=17?.17,248eligible adult participants were included in the present analyses to investigate the association between FPG and all-cause mortality.Moreover,623 non-CVD mortality participants were excluded,16,625 participants were included in the analysis to evaluate the association between FPG and CVD mortality.Participants were classified according to baseline FPG and diabetic status.Restricted cubic splines and Cox proportional-hazards regression models,estimating hazard ratio?HR?and 95%confidence interval?CI?,were used to assess the FPG with all-cause and CVD mortality relation.Results1.During the 6-year follow-up,1,107 people died,the death density?/1000person-years?and 95%CI was 10.91?10.28-11.56?,484 people died of CVD,the death density?/1000 person-years?and 95%CI was 4.88?4.45-5.33?.With the increase of FPG level,age,proportion of women,mild physical activity,body mass index?BMI?,systolic blood pressure?SBP?,diastolic blood pressure?DBP?,total cholesterol?TC?,triglycerides?TG?and low density lipoprotein cholesterol?LDL-C?increased,but the proportion of men,smokers,drinkers,high school or above,moderate and heavy physical activity and high density lipoprotein cholesterol?HDL-C?decreased(all P_trend<0.05).2.Among low fasting glucose?LFG?,normal fasting glucose?NFG?,impaired fasting glucose?IFG?and diabetes mellitus?DM?groups,DM had the highest death density of all-cause and CVD mortality.Cox proportional-hazards regression models revealed a significantly increased risk of all-cause mortality for people with DM and LFG versus NFG after adjusting for some potential confounders.The adjusted HR was 1.48?95%CI 1.06-2.07?for LFG and 1.90?95%CI 1.59-2.26?for DM,the risk of CVD mortality was increased for participants with DM versus NFG?HR 1.99,95%CI 1.54-2.57?.3.Restricted cubic splines analyses showed a J-shaped association between FPG on a continuous scale and all-cause and CVD mortality after adjusting for some potential confounders.After excluding participants using hypoglycemic medication,the association trend did not change.4.After stratified by lifestyle risk factors and health status,the relationship between LFG and all-cause mortality was more significant in male,age<50 years old and non-obese population.Except the age<50 years old and obesity population,there was no significant change in the relationship between FPG and all-cause and CVD mortality in the rest of the populations,and DM still significantly increased the risk of all-cause and CVD mortality.5.After exclusion of people with baseline FPG<2.78mmol/L,smokers,deaths within 1 years,people with cancer,and people with type 1 DM,both Cox proportional-hazards regression models and restricted cubic splines analyses showed that the relationship between FPG and all-cause and CVD mortality were essentially unchanged even after adjusting for some potential confounders.DM versus NFG significantly increased the risk of all-cause and CVD mortality.The HR and 95%CI were 1.91?1.54-2.38?and 1.91?1.40-2.60?,respectively.LFG increased the risk of all-cause death?HR 1.67,95%CI 1.08-2.57?.Conclusions1.Among LFG,NFG,IFG and DM groups,DM had the highest death density of all-cause and CVD mortality.2.A J-shaped relationship was found between FPG and all-cause and CVD mortality.Similar results were observed after sensitivity analyses.3.Risk of all-cause and CVD mortality was increased with DM versus NFG,and risk of all-cause mortality with LFG was increased positively.In sensitivity analyses,the results didn't change.