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Development of coronary heart disease and ischemic stroke in relation to fasting and 2-hour plasma glucose levels in the normal range

Feng Ning1*, Lei Zhang1234, Jacqueline M Dekker5, Altan Onat67, Coen DA Stehouwer8, John S Yudkin9, Tiina Laatikainen2, Jaakko Tuomilehto110112, Kalevi Pyörälä12, Qing Qiao12 and DECODE Finnish and Swedish Study Investigators

Author Affiliations

1 Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland

2 Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland

3 Qingdao Endocrine & Diabetes Hospital, Qingdao, China

4 Weifang Medical University, Weifang, China

5 Department of Epidemiology and Biostatistics EMGO, Institute for Health and Care Research VU University Medical Center, Amsterdam, the Netherlands

6 Turkish Society of Cardiology, Istanbul, Turkey

7 Department of Cardiology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey

8 Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, the Netherlands

9 University College London, WC1E 6BT, London, UK

10 South Ostrobothnia Central Hospital, Seinäjoki, Finland

11 Red RECAVA Grupo RD06/0014/0015, Hospital Universitario La Paz, Madrid, Spain

12 Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland

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Cardiovascular Diabetology 2012, 11:76  doi:10.1186/1475-2840-11-76

Published: 25 June 2012



Individuals who had normoglycemia but whose 2-hour plasma glucose (2hPG) concentrations did not return to the fasting plasma glucose (FPG) levels during an oral glucose tolerance test (OGTT) have been shown to have increased cardiovascular mortality. This is further investigated regarding to the first events of coronary heart disease (CHD) and ischemic stroke (IS).


Data from 9 Finnish and Swedish cohorts comprising 3743 men and 3916 women aged 25 to 90 years who had FPG < 6.1 mmol/l and 2hPG < 7.8 mmol/l and free of CVD at enrolment were analyzed. Hazard ratios (HRs) for first CHD and IS events were estimated for the individuals with 2hPG > FPG (Group II) compared with those having 2hPG ≤ FPG (Group I).


A total of 466 (115) CHD and 235 (106) IS events occurred in men (women) during a median follow-up of 16.4 years. Individuals in Group II were older and had greater body mass index, blood pressure, 2hPG and fasting insulin than those in Group I in both sexes. Multivariate adjusted HRs (95% confidence intervals) for incidence of CHD, IS, and composite CVD events (CHD + IS) in men were 1.13 (0.93-1.37), 1.40 (1.06-1.85) and 1.20 (1.01-1.42) in the Group II as compared with those in the Group I. The corresponding HRs in women were 1.33 (0.83-2.13), 0.94 (0.59-1.51) and 1.11 (0.79-1.54), respectively.


Within normoglycemic range individuals whose 2hPG did not return to their FPG levels during an OGTT had increased risk of CHD and IS.

Normoglycemia; Coronary heart disease; Ischemic stroke; Incidence