Association of low fasting glucose and HbA1c with cardiovascular disease and mortality: The MESA study

Morgana Mongraw-Chaffin, Alain G. Bertoni, Sherita Hill Golden, Nestoras Mathioudakis, Dorothy D. Sears, Moyses Szklo, Cheryl A.M. Anderson

Research output: Contribution to journalArticle

Abstract

Trials of intensive glucose control have not improved cardiovascular disease (CVD) risk in populations with type 2 diabetes; however, in the general population, reports are inconsistent about the effects of maintaining lower glucose levels. Some speculate that low glycemic values are associated with increased glycemic variability, which is in turn associated with higher CVD risk. It has also been suggested that fasting glucose and hemoglobin A1c (HbA1c) in the lower ranges have a different relationship with CVD and mortality. In 4990 participants from the Multi-Ethnic Study of Atherosclerosis, we used logistic regression to investigate associations of low fasting glucose (,80 mg/dL) and HbA1c (,5.0%) from baseline and averaged across follow-up with incident CVD and mortality over 13 years. We used normal glycemic ranges (80 to,100 mg/dL and 5.0 to,5.7%) as references and analyzed glycemic levels with visit-matched covariates. We adjusted for potential confounding by age, sex, race/ ethnicity, education, income, smoking status, body mass index, total cholesterol level, cholesterol medications, high-density lipoprotein cholesterol, and hypertension. Low baseline glucose and HbA1c were positively, but not significantly, associated with mortality, whereas low average fasting glucose and HbA1c were strongly and significantly associated with incident CVD [glucose OR, 2.04 (95% CI, 1.38-3.00); HbA1c OR, 2.01 (95% CI, 1.58-2.55)] and mortality [glucose OR, 1.93 (95% CI, 1.33-2.79); HbA1c OR, 2.51 (95% CI, 2.00-3.15)]. These results were not due to type 2 diabetes or medication use. Glucose variability did not explain CVD risk beyond average glucose levels. Chronic low fasting glucose and HbA1c may be better indicators of risk than a single low measurement.

Original languageEnglish (US)
Pages (from-to)892-901
Number of pages10
JournalJournal of the Endocrine Society
Volume3
Issue number5
DOIs
StatePublished - May 1 2019

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Fasting
Hemoglobins
Cardiovascular Diseases
Glucose
Mortality
Type 2 Diabetes Mellitus
Cholesterol
HDL Cholesterol
Population
Atherosclerosis
Reference Values
Body Mass Index
Logistic Models
Smoking
Hypertension
Education

Keywords

  • Cardiovascular disease
  • Epidemiology
  • Fasting glucose
  • HbA1c
  • Mortality

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

Cite this

Mongraw-Chaffin, M., Bertoni, A. G., Golden, S. H., Mathioudakis, N., Sears, D. D., Szklo, M., & Anderson, C. A. M. (2019). Association of low fasting glucose and HbA1c with cardiovascular disease and mortality: The MESA study. Journal of the Endocrine Society, 3(5), 892-901. https://doi.org/10.1210/js.2019-00033

Association of low fasting glucose and HbA1c with cardiovascular disease and mortality : The MESA study. / Mongraw-Chaffin, Morgana; Bertoni, Alain G.; Golden, Sherita Hill; Mathioudakis, Nestoras; Sears, Dorothy D.; Szklo, Moyses; Anderson, Cheryl A.M.

In: Journal of the Endocrine Society, Vol. 3, No. 5, 01.05.2019, p. 892-901.

Research output: Contribution to journalArticle

Mongraw-Chaffin, M, Bertoni, AG, Golden, SH, Mathioudakis, N, Sears, DD, Szklo, M & Anderson, CAM 2019, 'Association of low fasting glucose and HbA1c with cardiovascular disease and mortality: The MESA study', Journal of the Endocrine Society, vol. 3, no. 5, pp. 892-901. https://doi.org/10.1210/js.2019-00033
Mongraw-Chaffin, Morgana ; Bertoni, Alain G. ; Golden, Sherita Hill ; Mathioudakis, Nestoras ; Sears, Dorothy D. ; Szklo, Moyses ; Anderson, Cheryl A.M. / Association of low fasting glucose and HbA1c with cardiovascular disease and mortality : The MESA study. In: Journal of the Endocrine Society. 2019 ; Vol. 3, No. 5. pp. 892-901.
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