High blood glucose leading cause of cardiovascular deaths

10 November 2006

Higher-than-optimum blood glucose is a leading cause of cardiovascular mortality worldwide, a review published in The Lancet reveals.

The results indicate that one in five deaths from ischemic heart disease, and one in eight strokes are attributable to elevated blood glucose, researchers led by Majid Ezzati (Harvard School of Public Health, Boston, Massachusetts, USA) report.

Noting that cardiovascular mortality risk is known to increase continuously with increasing blood glucose, from concentrations well below the conventional thresholds used to define diabetes, Ezzati and team set out to quantify the effects of above-optimal levels of glucose at the population level.

The researchers collated data from 52 countries, including population health surveys, systematic reviews, and data provided by investigators to create a population distribution of fasting plasma glucose (FPG) levels in order to measure exposure to higher-than-optimum blood glucose.

They then conducted a systematic review of studies of the effects of FPG on cardiovascular disease mortality. For the primary analysis they used relative risks (RRs) for ischemic heart disease and stroke from a meta-analysis of more than 200,000 participants of 13 cohorts in the Asia-Pacific region.

This was the only meta-analysis to report RRs per unit FPG separately for heart disease and stroke, and also to provide individual participant data, rather than RRs pooled from epidemiologic studies, the authors note.

In addition to 960,000 deaths attributed to diabetes, 1.49 million deaths from ischemic heart disease and 709,000 deaths from stroke were attributable to blood glucose levels that were higher than normal but lower than that used to define diabetes. These accounted for 21% of all ischemic heart disease deaths, and 13% of all fatal strokes.

These findings indicate that the total mortality from higher-than-optimum concentrations of glucose worldwide is 3.16 million – considerably higher than the 960,000 deaths attributed to diabetes.

This figure is comparable to the number of deaths from smoking (4.8 million), high cholesterol (3.9 million), and overweight and obesity (2.4 million), the authors point out.

"Higher than optimum blood glucose is a leading cause of cardiovascular mortality in most world regions," they conclude.

They commented further: "Cardiovascular risk and diabetes management and control programs need to be more closely integrated rather than being in different spheres."

The Lancet 2006; 368: 1651-1659