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.
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