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A Prospective Study of Fasting Plasma Glucose and Risk of Stroke in Asymptomatic Men

  • Author Footnotes
    1 Supported by National Institutes of Health grants AG06945, HL62508, and R21DK088195 (to Dr Sui from the National Institute of Diabetes and Digestive and Kidney Diseases) and in part supported by an unrestricted research fund from The Coca-Cola Company.
    Xuemei Sui
    Correspondence
    Address correspondence to Xuemei Sui, MD, MPH, 921 Assembly St, Columbia, SC 29208
    Footnotes
    1 Supported by National Institutes of Health grants AG06945, HL62508, and R21DK088195 (to Dr Sui from the National Institute of Diabetes and Digestive and Kidney Diseases) and in part supported by an unrestricted research fund from The Coca-Cola Company.
    Affiliations
    Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia
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  • Carl J. Lavie
    Affiliations
    Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA
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  • Steven P. Hooker
    Affiliations
    Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia
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  • Duck-Chul Lee
    Affiliations
    Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia
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  • Natalie Colabianchi
    Affiliations
    Department of Biostatistics and Epidemiology, Arnold School of Public Health, University of South Carolina, Columbia
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  • Chong-Do Lee
    Affiliations
    Department of Exercise and Wellness, Arizona State University, Mesa
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  • Steven N. Blair
    Affiliations
    Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia

    Department of Biostatistics and Epidemiology, Arnold School of Public Health, University of South Carolina, Columbia
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  • Author Footnotes
    1 Supported by National Institutes of Health grants AG06945, HL62508, and R21DK088195 (to Dr Sui from the National Institute of Diabetes and Digestive and Kidney Diseases) and in part supported by an unrestricted research fund from The Coca-Cola Company.

      OBJECTIVE:

      To examine the association between levels of fasting plasma glucose (FPG) and incidence of stroke outcomes in a large cohort of asymptomatic men.

      PATIENTS AND METHODS

      Participants were 43,933 men (mean ± SD age, 44.3±9.9 years) who were free of known cardiovascular disease at baseline and whose FPG levels were assessed during a preventive medical examination at the Cooper Clinic, Dallas, TX, between January 7, 1971, and March 11, 2002. Patients with diagnosed diabetes mellitus (DM) or low FPG (<80 mg/dL [to convert to mmol/L, multiply by 0.0555]) were excluded. Fatal stroke was identified through the National Death Index, and nonfatal stroke was ascertained from mail-back surveys.

      RESULTS

      A total of 595 stroke events (156 fatal and 456 nonfatal strokes; 17 men reported a nonfatal stroke before they died of stroke) occurred during 702,928 person-years of exposure. Age-adjusted fatal, nonfatal, and total stroke event rates per 10,000 person-years for normal FPG (80-109 mg/dL), impaired fasting glucose (110-125 mg/dL), and undiagnosed DM (>126 mg/dL) were 2.1, 3.4, and 4.0 (ptrend=.002); 10.3, 11.8, and 18.0 (ptrend=.008); and 8.2, 9.6, and 12.4 (ptrend=.008), respectively. After further adjusting for potential confounders, the direct association between FPG and fatal, nonfatal, or total stroke events remained significant (Ptrend=.02, .03, and .01, respectively). For FPG levels of 110 mg/dL or greater, each 10-unit increment of FPG was associated with a 6% higher risk of total stroke events (p=.05).

      CONCLUSION

      Hyperglycemia (FPG, >110 mg/dL), even below the DM threshold (such as with impaired fasting glucose), was associated with a higher risk of fatal, nonfatal, or total stroke events in asymptomatic men.
      ACLS (Aerobics Center Longitudinal Study), ADA (American Diabetes Association), BMI (body mass index), CI (confidence interval), CVD (cardiovascular disease), DM (diabetes mellitus), ECG (electrocardiography), FPG (fasting plasma glucose), ICD (International Classification of Diseases), IFG (impaired fasting glucose), MetS (metabolic syndrome), NDI (National Death Index)
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