Abstract
Background: Glucose intolerance is clearly associated with increasing risk of cardiovascular disease, but the association among increasing glycemia and cardiovascular risk factors, angina and coronary heart disease in normoglycemic subjects is less clear, particularly in Chinese. Methods: A total of 2763 subjects were recruited and the prevalence of glucose intolerance investigated, using fasting or 2-h 75-g oral glucose tolerance test (OGTT), glucose levels. Subjects normoglycemic by both criteria were selected and the relationship between glycemia and cardiovascular risk factors investigated using analysis of variance and stepwise multiple linear regression analyses. Results: 1931 (69.9%) subjects were normoglycemic by both tests. After adjustment for age and gender, quartiles of fasting and post-load glucose levels showed a clear positive relationship with cardiovascular risk factors, including obesity, blood pressure and lipid levels (p<0.001 for all). Additionally, other measures of glycemia and insulin resistance also dose-dependently increased with increasing fasting and post-load glucose levels (p<0.001 for all). Stepwise multiple regression showed that in females, age (standardised regression coefficient β (β)=0.23, p<0.001), insulin (β=0.17, p<0.001), waist circumference (β=0.11, p=0.007) were independently associated with fasting glucose levels; and body mass index (β=0.17, p<0.001), age (β=0.15, p<0.001) and triglycerides (β=0.15, p<0.001) were independently associated with post-load glucose levels. In males, age (β=0.19, p<0.001) and insulin (β=0.18, p<0.001) were independently associated with fasting glucose levels; and waist circumference (β=0.17, p<0.001 ), triglycerides (β=0.16, p<0.001) and insulin (β=0.12, p=0.001) were independently associated with post-load glucose levels.
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Stamler J, Vaccaro O, Neaton JD, Wentworth D. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care 1993, 16: 434–44.
Chan JCN, Cockram CS. Diabetes in the Chinese population and its implications for health care. Diabetes Care 1997, 20: 1785–90.
Kannel WB, McGee DL. Diabetes and cardiovascular risk factors: the Framingham Study. JAMA 1979, 59: 8–13.
Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998, 339: 229–34.
Tominaga M, Eguchi H, Manaka H, et al. Impaired glucose tolerance is a risk factor for cardiovascular disease, but not impaired fasting glucose: The Funagata Diabetes Study. Diabetes Care 1999, 22: 920–4.
Saydah SH, Loria CM, Eberhardt MS, Brancati FL. Subclinical states of glucose intolerance and risk of death in the US. Diabetes Care 2001, 24: 447–53.
Genuth S, Alberti KG, Bennett P, et al. Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care 2003, 26: 3160–7.
Liao D, Shofer JB, Boyko EJ, et al. Abnormal glucose tolerance and increased risk for cardiovascular disease in Japanese-Americans with normal fasting glucose. Diabetes Care 2001, 24: 39–44.
Tirosh A, Shai I, Tekes-Manova D, et al. Normal fasting plasma glucose levels and type 2 diabetes in young men. N Engl J Med 2005, 353: 1454–62.
Thomas GN, Chook P, Qiao M, et al. Deleterious impact of “high normal” glucose levels and other metabolic syndrome components on arterial endothelial function and intima-media thickness in apparently healthy Chinese subjects: the CATHAY study. Arterioscler Thromb Vasc Biol 2004, 24: 739–43.
Lam TH, Kleevens JWL, Wong CM. Doctor consultation in Hong Kong: a comparison between findings of a telephone interview with the general household survey. Community Med 1988, 10: 175–9.
Lam TH, Liu LJ, Janus ED, Bourke C, Hedley AJ. The relationship between fibrinogen and other coronary heart disease risk factors in a Chinese population. Atherosclerosis 1999, 143: 405–13.
E.D. Janus for the Hong Kong Cardiovascular Risk Factor Prevalence Study Group: The Hong Kong Cardiovascular Risk Factor Prevalence Study 1995–1996. Hong Kong: Department of Clinical Biochemistry, Queen Mary Hospital. 1997, 1–145.
Joint National Committee [JNC]-VI. The sixth report of the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure. Arch Intern Med 1997, 157: 2413–46.
Report of the Expert Committee on the Diagnosis and Classification. Diabetes Care 1997, 20: 1183–97.
Mathews DR, Hoskers JP, Rudenski AS, et al. Homeostasis model assessment of insulin resistance and B-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985, 28: 412–9.
Dowse GK, Qin H, Collins VR, et al. Determinants of estimated insulin resistance and beta-cell function in Indian, Creole and Chinese Mauritians. The Mauritius NCD Study Group. Diabetes Res Clin Pract 1990, 10: 265–79.
Expert Panel on Detection Evaluation and Treatment of High Blood Cholesterol in Adults: Executive summary of the third report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001, 285: 2486–97.
World Health Organization Western Pacific Region. The Asia-Pacific perspective: redefining obesity and its treatment: Health Communications, Australia, 2000 [Reference can be found at http://www.diabetes.com.au/pdf/obesity_report.pdf; access date 2 Nov 2005], 1–56.
Wong SP, Cockram CS, Janus ED, et al. Guide to plasma lipids and lipoproteins for Hong Kong doctors. J Hong Kong Coll Cardiol 1996, 4: 81–9.
De Vriese AS, Verbeuren TJ, Van de Voorde J, Lameire NH, Vanhoutte PM. Endothelial dysfunction in diabetes. Br J Pharmacol 2000, 130: 963–74.
Vlassara H, Palace MR. Diabetes and advanced glycation endproducts. J Intern Med 2002, 251: 87–101.
Fujioka S, Matzuzawa Y, Tokunaga K, Tarui S. Contribution of intra-abdominal fat accumulation to the impairment of glucose and lipid metabolism in human obesity. Metabolism 1987, 36: 54–9.
Matsuzawa Y. Pathophysiology and molecular mechanisms of visceral fat syndrome: the Japanese experience. Diabetes Metab Rev 1997, 13: 3–13.
Bonadonna RC, Bonora E. Glucose and free fatty acid metabolism in human obesity. Diabetes Rev 1997, 5: 21–51.
Ferrannini E, Barrett EJ, Bevilacqua S, DeFronzo R. Effects of fatty acids on glucose production and utilisation in man. J Clin Invest 1983, 72: 1737–47.
Chan JCN, Cheung JCK, Lau EMC, et al. The metabolic syndrome in Hong Kong Chinese. The interrelationships among its components analyzed by structural equation modeling. Diabetes Care 1996, 19: 953–9.
Thomas GN, Ho SY, Janus ED, et al. The US National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) prevalence of the metabolic syndrome in a Chinese population: the Hong Kong Cardiovascular Risk Factor Study. Diabetes Res Clin Pract 2005, 67: 251–7
Anderson PJ, Critchley JA, Chan JC, et al. Factor analysis of the metabolic syndrome: obesity vs insulin resistance as the central abnormality. Int J Obes 2001, 25: 1782–8.
Thomas GN, Critchley JAJH, Tomlinson B, et al. Obesity, independent of insulin resistance, is a major determinant of blood pressure in normoglycaemic Hong Kong Chinese. Metabolism 2000, 49: 1523–8
Haffner SM, Miettinen H, Stern MP. The homeostatic model in the San Antonio Heart Study. Diabetes Care 1997, 20: 1087–92
Abate N, Garg A, Peshock RM, Stray-Gundersen J, Grundy SM. Relationships of generalized and regional adiposity to insulin sensitivity in men. J Clin Invest 1995, 96: 88–98.
Vanhala MJ, Pitkäjärvi TK, Kumpusalo EA, Takala JK. Obesity type and clustering of insulin resistance-associated cardiovascular risk factors in middle-aged men and women. Int J Obes 1998, 22: 369–74.
Ross R, Leger L, Morris D, de Guisse J, Guardo R. Quantification of adipose tissue by MRI: relationship with anthropometric variables. J Appl Physiol 1992, 72: 787–95.
Anderson PJ, Chan JCN, Chan YL, et al. Visceral fat and cardiovascular risk factors in Chinese NIDDM patients. Diabetes Care 1997, 20: 1854–8
The DECODE Study Group. Gender difference in all-cause and cardiovascular mortality related to hyperglycaemia and newly-diagnosed diabetes. Diabetologia 2003, 46: 608–17.
Williams JW, Zimmet PZ, Shaw JE, et al. Gender differences in the prevalence of impaired fasting glycaemia and impaired glucose tolerance in Mauritius. Does sex matter? Diabet Med 2003, 20: 915–20.
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Thomas, G.N., McGhee, S.M., Schooling, C.M. et al. Determinants of normoglycemia and contribution to cardiovascular risk factors in a Chinese population: The Hong Kong Cardiovascular Risk Factor Study. J Endocrinol Invest 29, 528–535 (2006). https://doi.org/10.1007/BF03344143
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DOI: https://doi.org/10.1007/BF03344143