Post-challenge blood glucose concentration and stroke mortality rates in non-diabetic men in London: 38-year follow-up of the original Whitehall prospective cohort study
While individuals with diabetes have a raised risk of stroke, it is unclear whether hyperglycaemia in non-diabetic populations is related to the development of this disease.
In this prospective cohort study of 19,019 men, capillary blood was drawn 2 h after consumption of a glucose preparation equivalent to 50 g of anhydrous dextrose. Study participants were then followed for mortality for a maximum of 38 years.
During follow-up of 18,406 non-diabetic men, 13,116 deaths occurred (1,189 by stroke). Plots of stroke mortality rates versus blood glucose identified an upward inflection in risk of death from stroke at about 4.6 mmol/l. This upward inflection in risk could be adequately described using a single linear term above this threshold. A 1 mmol/l increase in blood glucose after this point was associated with a 27% increase in risk of death from stroke (hazard ratio 1.27, 95% CI 1.14–1.42). This increase in risk was partially attenuated by adjustment for covariates (1.17, 1.04–1.31) but remained statistically significant at conventional levels. Similar observations were made when all-cause mortality was the outcome of interest, although the magnitude of the association with blood glucose was somewhat lower.
An incremental elevation in stroke mortality rates occurs with increasing post-challenge blood glucose.
- Wannamethee, SG, Perry, IJ, Shaper, AG (1999) Nonfasting serum glucose and insulin concentrations and the risk of stroke. Stroke 30: pp. 1780-1786
- Folsom, AR, Rasmussen, ML, Chambless, LE (1999) Prospective associations of fasting insulin, body fat distribution, and diabetes with risk of ischemic stroke. The atherosclerosis risk in communities (ARIC) study investigators. Diabetes Care 22: pp. 1077-1083 CrossRef
- Haheim, LL, Holme, I, Hjermann, I, Leren, P (1995) Nonfasting serum glucose and the risk of fatal stroke in diabetic and nondiabetic subjects. 18-year follow-up of the Oslo Study. Stroke 26: pp. 774-777
- Hart, CL, Hole, DJ, Davey Smith, G (1999) Risk factors and 20-year stroke mortality in men and women in the Renfrew/Paisley study in Scotland. Stroke 30: pp. 1999-2007
- Myint, PK, Sinha, S, Wareham, NJ (2007) Glycated hemoglobin and risk of stroke in people without known diabetes in the European Prospective Investigation into Cancer (EPIC)-Norfolk prospective population study: a threshold relationship?. Stroke 38: pp. 271-275 CrossRef
- Glucose tolerance and cardiovascular mortality: comparison of fasting and 2-hour diagnostic criteria. Arch Intern Med 161: pp. 397-405 CrossRef
- Fuller, JH, Shipley, MJ, Rose, G, Jarrett, RJ, Keen, H (1983) Mortality from coronary heart disease and stroke in relation to degree of glycaemia: the Whitehall study. BMJ 287: pp. 867-870 CrossRef
- Reid, DD, Hamilton, PJS, McCartney, P (1974) Cardiorespiratory disease and diabetes among middle-aged male civil servants. Lancet 1: pp. 469-473 CrossRef
- Pan, WH, Cedres, LB, Liu, K (1986) Relationship of clinical diabetes and asymptomatic hyperglycemia to risk of coronary heart disease mortality in men and women. Am J Epidemiol 123: pp. 504-516
- Yano, K, Kagan, A, McGee, D, Rhoads, GG (1982) Glucose intolerance and nine-year mortality in Japanese men in Hawaii. Am J Med 72: pp. 71-80 CrossRef
- Jarrett, RJ, Keen, H, McCartney, M (1978) Glucose tolerance and blood pressure in two population samples: their relation to diabetes mellitus and hypertension. Int J Epidemiol 7: pp. 15-24 CrossRef
- Fuller, JH, Shipley, MJ, Rose, G, Jarrett, RJ, Keen, H (1980) Coronary-heart-disease risk and impaired glucose tolerance. The Whitehall study. Lancet 1: pp. 1373-1376
- Hart, CL, Hole, DJ, Davey Smith, G (2000) Comparison of risk factors for stroke incidence and stroke mortality in 20 years of follow-up in men and women in the Renfrew/Paisley Study in Scotland. Stroke 31: pp. 1893-1896
- Hasuo, Y, Ueda, K, Kiyohara, Y (1989) Accuracy of diagnosis on death certificates for underlying causes of death in a long-term autopsy-based population study in Hisayama, Japan; with special reference to cardiovascular diseases. J Clin Epidemiol 42: pp. 577-584 CrossRef
- Durrleman, S, Simon, R (1989) Flexible regression models with cubic splines. Stat Med 8: pp. 551-561 CrossRef
- Brunner, EJ, Shipley, MJ, Witte, DR, Fuller, JH, Marmot, MG (2006) Relation between blood glucose and coronary mortality over 33 years in the Whitehall Study. Diabetes Care 29: pp. 26-31 CrossRef
- Post-challenge blood glucose concentration and stroke mortality rates in non-diabetic men in London: 38-year follow-up of the original Whitehall prospective cohort study
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
Volume 51, Issue 7 , pp 1123-1126
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Blood glucose
- Industry Sectors
- Author Affiliations
- 1. MRC Social and Public Health Sciences Unit, University of Glasgow, 4 Lilybank Gardens, Glasgow, G12 8RZ, UK
- 2. Department of Epidemiology and Public Health, University College London, London, UK
- 3. Department of Social Medicine, University of Bristol, Bristol, UK