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

Erika F. Brutsaert, Sanyog G. Shitole, Mary Lou Biggs, Kenneth J. Mukamal, Ian H. DeBoer, Evan L. Thacker, Joshua I. Barzilay, Luc Djoussé, Joachim H. Ix, Nicholas L. Smith, Robert C. Kaplan, David S. Siscovick, Bruce M. Psaty, Jorge Kizer

Research output: Contribution to journalArticle

7 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)370-377
Number of pages8
JournalJournals of Gerontology - Series A Biological Sciences and Medical Sciences
Volume71
Issue number3
DOIs
StatePublished - Mar 1 2016

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Fasting
Cardiovascular Diseases
Glucose
Mortality
Health
Independent Living
Social Adjustment
Hyperglycemia

Keywords

  • Cardiovascular
  • Diabetes
  • Epidemiology
  • Risk factors

ASJC Scopus subject areas

  • Aging
  • Geriatrics and Gerontology

Cite this

Relations of Postload and Fasting Glucose With Incident Cardiovascular Disease and Mortality Late in Life : The Cardiovascular Health Study. / Brutsaert, Erika F.; Shitole, Sanyog G.; Biggs, Mary Lou; Mukamal, Kenneth J.; DeBoer, Ian H.; Thacker, Evan L.; Barzilay, Joshua I.; Djoussé, Luc; Ix, Joachim H.; Smith, Nicholas L.; Kaplan, Robert C.; Siscovick, David S.; Psaty, Bruce M.; Kizer, Jorge.

In: Journals of Gerontology - Series A Biological Sciences and Medical Sciences, Vol. 71, No. 3, 01.03.2016, p. 370-377.

Research output: Contribution to journalArticle

Brutsaert, EF, Shitole, SG, Biggs, ML, Mukamal, KJ, DeBoer, IH, Thacker, EL, Barzilay, JI, Djoussé, L, Ix, JH, Smith, NL, Kaplan, RC, Siscovick, DS, Psaty, BM & Kizer, J 2016, 'Relations of Postload and Fasting Glucose With Incident Cardiovascular Disease and Mortality Late in Life: The Cardiovascular Health Study', Journals of Gerontology - Series A Biological Sciences and Medical Sciences, vol. 71, no. 3, pp. 370-377. https://doi.org/10.1093/gerona/glv106
Brutsaert, Erika F. ; Shitole, Sanyog G. ; Biggs, Mary Lou ; Mukamal, Kenneth J. ; DeBoer, Ian H. ; Thacker, Evan L. ; Barzilay, Joshua I. ; Djoussé, Luc ; Ix, Joachim H. ; Smith, Nicholas L. ; Kaplan, Robert C. ; Siscovick, David S. ; Psaty, Bruce M. ; Kizer, Jorge. / Relations of Postload and Fasting Glucose With Incident Cardiovascular Disease and Mortality Late in Life : The Cardiovascular Health Study. In: Journals of Gerontology - Series A Biological Sciences and Medical Sciences. 2016 ; Vol. 71, No. 3. pp. 370-377.
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T2 - The Cardiovascular Health Study

AU - Brutsaert, Erika F.

AU - Shitole, Sanyog G.

AU - Biggs, Mary Lou

AU - Mukamal, Kenneth J.

AU - DeBoer, Ian H.

AU - Thacker, Evan L.

AU - Barzilay, Joshua I.

AU - Djoussé, Luc

AU - Ix, Joachim H.

AU - Smith, Nicholas L.

AU - Kaplan, Robert C.

AU - Siscovick, David S.

AU - Psaty, Bruce M.

AU - Kizer, Jorge

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N2 - 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.

AB - 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.

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