Fasting and postchallenge hyperglycemia and risk of cardiovascular disease in Chinese: The Chin-Shan Community Cardiovascular Cohort study

Background Whether fasting glucose is superior to postchallenge glucose or insulin level for prediction of cardiovascular disease (CVD) remains controversial. The aim of our study was to compare fasting, postchallenge glucose and other markers as predictors of CVD in a community-based prospective cohort study among 2,165 adult participants. Methods A standard 75-g oral glucose tolerance test was performed, with measurements of fasting and 2-hour postchallenge plasma glucose and insulin levels. We defined the CVD outcome as incident coronary heart disease and stroke. Cox regression model was used to estimate the relative risk (RR) for CVD. Results A total of 166 individuals developed major CVD events during 10.5 years of follow-up. Both fasting and postchallenge glucose were significantly associated with CVD risk (adjusted RR in the highest quartile vs the lowest quartile 1.74, 95% confidence interval [CI] 1.06-2.86 for fasting glucose; RR in highest quartile 2.05, 95% CI 1.23-3.42 for postchallenge glucose). Postchallenge and fasting glucose had similar areas of receiver operative characteristics curves (0.65, 95% CI 0.58-0.72 for postchallenge glucose; 0.65, 95% CI 0.58-0.72 for fasting glucose). In mutually adjusted models, fasting and postchallenge glucose remained significant risk factors for CVD, whereas insulin resistance variables became nonsigificant. Conclusions These findings show that fasting and postchallenge glucose concentrations are independent predictors of CVD risk among ethnic Chinese in Taiwan. (Am Heart J 2008; 156:996-1002.)