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?

TitleGlycated 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?
Publication TypeJournal Article
Year of Publication2007
AuthorsMyint, PK, Sinha, S, Wareham, NJ, Bingham, SA, Luben, RN, Welch, AA, Khaw, K-T
JournalStroke
Volume38
Issue2
Pagination271-5
Date Published2007 Feb
ISSN1524-4628
KeywordsAdult, Aged, Blood Glucose, Cohort Studies, Diabetes Mellitus, England, Europe, Female, Glycated Hemoglobin A, Humans, Male, Middle Aged, Neoplasms, Population, Prospective Studies, Risk Factors, Stroke
Abstract

BACKGROUND AND PURPOSE: Diabetes is a well-recognized risk factor for cardiovascular diseases. Evidence suggests a linear relationship between blood glucose and myocardial infarction, even at blood glucose concentrations below the threshold for diabetes. The relationship between blood glucose concentration and stroke in people without established diabetes has been studied less extensively.METHODS: We examined the prospective relationship between usual blood glucose level measured by glycohemoglobin (HbA(1c)) concentrations and incident stroke risk in a general population without diabetes and stroke at baseline assessment in the European Prospective Investigation Into Cancer (EPIC)-Norfolk.RESULTS: A total of 10,489 men and women aged 40 to 79 years at baseline were followed up (mean=8.5 years). Mean age, systolic and diastolic blood pressure, body mass index, total cholesterol, triglycerides, and proportion of current smokers increased and mean high-density lipoprotein cholesterol decreased with increasing HbA(1c) concentrations. There were 164 incident strokes identified over 88 652 person-years. After adjustment for age, sex, and cardiovascular risk factors, the relative risks (95% CI) for stroke for participants with HbA(1c) concentrations 5% to 5.4%, 5.5% to 6.9%, and > or =7% were 0.78 (0.50 to 1.22), 0.83 (0.54 to 1.27), and 2.83 (1.40 to 5.74), respectively, compared with those with HbA(1c) <5%.CONCLUSIONS: In contrast to the continuous linear relationship observed between blood glucose level and coronary heart disease risk, the association between blood glucose level and stroke risk appears to be more consistent with a threshold relationship. These observations may give insights into the differing pathogenesis of different vascular diseases.

DOI10.1161/01.STR.0000254549.75763.5f
Alternate JournalStroke
Citation Key10.1161/01.STR.0000254549.75763.5f
PubMed ID17204684
Grant ListG0401527 / / Medical Research Council / United Kingdom
MC_U106179471 / / Medical Research Council / United Kingdom