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?

Phyo K Myint, Shubhada Sinha, Nicholas J Wareham, Sheila A Bingham, Robert N Luben, Ailsa A Welch, Kay-Tee Khaw

Research output: Contribution to journalArticle

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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.

Original languageEnglish
Pages (from-to)271-275
Number of pages5
JournalStroke
Volume38
Issue number2
DOIs
Publication statusPublished - Feb 2007

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Glycosylated Hemoglobin A
Blood Glucose
Stroke
Prospective Studies
Population
Neoplasms
Blood Pressure
Vascular Diseases
HDL Cholesterol
Coronary Disease
Triglycerides
Body Mass Index
Cardiovascular Diseases
Myocardial Infarction
Cholesterol

Keywords

  • Adult
  • Aged
  • Blood Glucose
  • Cohort Studies
  • Diabetes Mellitus
  • England
  • Europe
  • Female
  • Hemoglobin A, Glycosylated
  • Humans
  • Male
  • Middle Aged
  • Neoplasms
  • Population
  • Prospective Studies
  • Risk Factors
  • Stroke

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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? / Myint, Phyo K; Sinha, Shubhada; Wareham, Nicholas J; Bingham, Sheila A; Luben, Robert N; Welch, Ailsa A; Khaw, Kay-Tee.

In: Stroke, Vol. 38, No. 2, 02.2007, p. 271-275.

Research output: Contribution to journalArticle

Myint, Phyo K ; Sinha, Shubhada ; Wareham, Nicholas J ; Bingham, Sheila A ; Luben, Robert N ; Welch, Ailsa A ; Khaw, Kay-Tee. / 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?. In: Stroke. 2007 ; Vol. 38, No. 2. pp. 271-275.
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T1 - Glycated hemoglobin and risk of stroke in people without known diabetes in the European Prospective Investigation into Cancer (EPIC)-Norfolk prospective population study

T2 - a threshold relationship?

AU - Myint, Phyo K

AU - Sinha, Shubhada

AU - Wareham, Nicholas J

AU - Bingham, Sheila A

AU - Luben, Robert N

AU - Welch, Ailsa A

AU - Khaw, Kay-Tee

PY - 2007/2

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N2 - 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.

AB - 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.

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KW - Aged

KW - Blood Glucose

KW - Cohort Studies

KW - Diabetes Mellitus

KW - England

KW - Europe

KW - Female

KW - Hemoglobin A, Glycosylated

KW - Humans

KW - Male

KW - Middle Aged

KW - Neoplasms

KW - Population

KW - Prospective Studies

KW - Risk Factors

KW - Stroke

U2 - 10.1161/01.STR.0000254549.75763.5f

DO - 10.1161/01.STR.0000254549.75763.5f

M3 - Article

C2 - 17204684

VL - 38

SP - 271

EP - 275

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 2

ER -