Low fasting glucose and future risks of major adverse outcomes in people without baseline diabetes or cardiovascular disease: a systematic review and meta-analysis
Objective To investigate the link between low fasting blood glucose levels and all-cause mortality and cardiovascular outcomes among people without baseline diabetes or cardiovascular disease.Design Systematic review and meta-analysis.Data sources PubMed and Embase (1966–February 2019).Selection cri...
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| Format: | Article |
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BMJ Publishing Group
2019-07-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/7/e026010.full |
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| author | Hsin-Chieh Yeh Hung-Wei Liao Jeffrey Saver Chi-Hsin Sally Chen Yi-Ling Wu Meng Lee Bruce Ovbiagele |
| author_facet | Hsin-Chieh Yeh Hung-Wei Liao Jeffrey Saver Chi-Hsin Sally Chen Yi-Ling Wu Meng Lee Bruce Ovbiagele |
| author_sort | Hsin-Chieh Yeh |
| collection | DOAJ |
| description | Objective To investigate the link between low fasting blood glucose levels and all-cause mortality and cardiovascular outcomes among people without baseline diabetes or cardiovascular disease.Design Systematic review and meta-analysis.Data sources PubMed and Embase (1966–February 2019).Selection criteria Prospective cohort studies were included for meta-analysis if they reported adjusted HRs with 95% CIs for associations between risk of all-cause mortality, stroke, major cardiovascular events, coronary heart disease and low fasting glucose levels (<4.6 mmol/L and/or 4.0 mmol/L, respectively) versus normal fasting glucose levels.Data extraction and statistical analysis Two independent reviewers extracted data from eligible studies. Heterogeneity was assessed by p value of χ2 tests and I2. We assessed four characteristics for each included study based on items developed by the US Preventive Task Force, as well as the modified checklist used in previous studies.Results Eleven articles (consisting of 129 prospective cohort studies) with 2 674 882 participants without diabetes and cardiovascular disease at baseline were included in this meta-analysis. Pooled results from the random effects model showed increased risks of all-cause mortality (HR: 1.56; 95% CI 1.09 to 2.23), total stroke (HR: 1.08, 95% CI 1.03 to 1.13) and ischaemic stroke (HR: 1.06, 95% CI 1.01 to 1.10), and major cardiovascular events (HR: 1.05, 95% CI 1.03 to 1.07) among people with a fasting glucose <4.0 mmol/L, as compared with people with normal fasting glucose. The less stringent low fasting glucose level, <4.6 mmol/L, was not associated with increased risk of any endpoints.Discussion and conclusions Among people without baseline diabetes or cardiovascular disease, a fasting blood glucose level of <4.0 mmol/L is associated with increased risk of all-cause mortality, major cardiovascular events and stroke. |
| format | Article |
| id | doaj-art-acfb09a705d54fd68ac42d2ec15252e8 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-acfb09a705d54fd68ac42d2ec15252e82025-08-20T02:06:50ZengBMJ Publishing GroupBMJ Open2044-60552019-07-019710.1136/bmjopen-2018-026010Low fasting glucose and future risks of major adverse outcomes in people without baseline diabetes or cardiovascular disease: a systematic review and meta-analysisHsin-Chieh Yeh0Hung-Wei Liao1Jeffrey Saver2Chi-Hsin Sally Chen3Yi-Ling Wu4Meng Lee5Bruce Ovbiagele6Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USADepartment of Nephrology, Chinru Clinic, Taipei, TaiwanDepartment of Neurology, University of California System, Los Angeles, California, USACollege of Public Health, National Taiwan University, Taipei, TaiwanInstitute of Population Health Sciences, National Health Research Institutes, Zhunan, TaiwanDepartment of Neurology, Chang Gung University, Kwei-Shan, Taoyuan, Taiwan6 Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, USAObjective To investigate the link between low fasting blood glucose levels and all-cause mortality and cardiovascular outcomes among people without baseline diabetes or cardiovascular disease.Design Systematic review and meta-analysis.Data sources PubMed and Embase (1966–February 2019).Selection criteria Prospective cohort studies were included for meta-analysis if they reported adjusted HRs with 95% CIs for associations between risk of all-cause mortality, stroke, major cardiovascular events, coronary heart disease and low fasting glucose levels (<4.6 mmol/L and/or 4.0 mmol/L, respectively) versus normal fasting glucose levels.Data extraction and statistical analysis Two independent reviewers extracted data from eligible studies. Heterogeneity was assessed by p value of χ2 tests and I2. We assessed four characteristics for each included study based on items developed by the US Preventive Task Force, as well as the modified checklist used in previous studies.Results Eleven articles (consisting of 129 prospective cohort studies) with 2 674 882 participants without diabetes and cardiovascular disease at baseline were included in this meta-analysis. Pooled results from the random effects model showed increased risks of all-cause mortality (HR: 1.56; 95% CI 1.09 to 2.23), total stroke (HR: 1.08, 95% CI 1.03 to 1.13) and ischaemic stroke (HR: 1.06, 95% CI 1.01 to 1.10), and major cardiovascular events (HR: 1.05, 95% CI 1.03 to 1.07) among people with a fasting glucose <4.0 mmol/L, as compared with people with normal fasting glucose. The less stringent low fasting glucose level, <4.6 mmol/L, was not associated with increased risk of any endpoints.Discussion and conclusions Among people without baseline diabetes or cardiovascular disease, a fasting blood glucose level of <4.0 mmol/L is associated with increased risk of all-cause mortality, major cardiovascular events and stroke.https://bmjopen.bmj.com/content/9/7/e026010.full |
| spellingShingle | Hsin-Chieh Yeh Hung-Wei Liao Jeffrey Saver Chi-Hsin Sally Chen Yi-Ling Wu Meng Lee Bruce Ovbiagele Low fasting glucose and future risks of major adverse outcomes in people without baseline diabetes or cardiovascular disease: a systematic review and meta-analysis BMJ Open |
| title | Low fasting glucose and future risks of major adverse outcomes in people without baseline diabetes or cardiovascular disease: a systematic review and meta-analysis |
| title_full | Low fasting glucose and future risks of major adverse outcomes in people without baseline diabetes or cardiovascular disease: a systematic review and meta-analysis |
| title_fullStr | Low fasting glucose and future risks of major adverse outcomes in people without baseline diabetes or cardiovascular disease: a systematic review and meta-analysis |
| title_full_unstemmed | Low fasting glucose and future risks of major adverse outcomes in people without baseline diabetes or cardiovascular disease: a systematic review and meta-analysis |
| title_short | Low fasting glucose and future risks of major adverse outcomes in people without baseline diabetes or cardiovascular disease: a systematic review and meta-analysis |
| title_sort | low fasting glucose and future risks of major adverse outcomes in people without baseline diabetes or cardiovascular disease a systematic review and meta analysis |
| url | https://bmjopen.bmj.com/content/9/7/e026010.full |
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