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Abstract

This study assessed the effect of serum glucose on the association of baseline serum cholesterol with subsequent ischemic heart disease events. Baseline serum cholesterol and glucose levels were available for 11766 hypertension patients who participated in a systematic treatment program for >6 months. After excluding 1431 with baseline history of cardiovascular disease, 10335 were available for the study. The 7659 with normal glucose defined as <110 mg/dl were compared to those with either serum glucose >=110 (n=2539) or with history of diabetes at entry (n=137). Serum cholesterol was categorized as < 180, 180-199, 200-219, 220-239, 240-259 and >= 260 mg/dl. Outcome events were hospitalizations or deaths from ischemic heart disease (IHD) (ICD-9 codes 410-414), plus revascularizations and angioplasty. Age-sex adjusted event rates for the cholesterol categories were calculated for both glucose strata. Hazard ratios adjusted for age, sex, smoking, systolic blood pressure, left ventricular hypertrophy, body-mass index, ethnicity and treatment status at entry were calculated with Cox models. During 5.9 years average follow-up, there were 342 IHD events. The abnormal glucose group had higher age-sex adjusted rates in each cholesterol category. Only the highest cholesterol category (>= 260) was significantly associated with IHD among the normal glucose stratum. In contrast, each cholesterol category >=180(with <180 as reference) in the abnormal glucose stratum was significantly associated with IHD, with hazard ratios consistently greater than 2. Although high levels of serum cholesterol and glucose are well established as independent risk factors for atherosclerosis and ischemic heart disease, these datasuggest an interaction effect should be considered. Among hypertensive patients, even cholesterol levels >=180 may be associated with greater risk of IHD in the presence of abnormal serum glucose, while among patients with normal serum glucose the risk associated with cholesterol might be attenuated. (See Table)

Glucose < 110 mg/dlGlucose >= 110 mg/dl or Hx Diabetes
Cholesterol (mg/dl)IHD rate*Hazard Ratio** (95% CI)IHD rate*Hazard Ratio** (95% CI)
<1803.71.0 (reference)4.31.0 (reference)
180-1994.61.1 (0.6-1.9)8.22.3 (1.0-5.6)
200-2196.21.5 (0.9-2.4)7.82.4 (1.0-5.5)
220-2394.01.0 (0.6-1.6)9.02.4 (1.0-5.5)
249-2594.00.9 (0.5-1.6)11.23.6 (1.6-8.3)
260+9.71.9 (1.2-3.0)11.62.9 (1.3-6.5)
Glucose < 110 mg/dlGlucose >= 110 mg/dl or Hx Diabetes
Cholesterol (mg/dl)IHD rate*Hazard Ratio** (95% CI)IHD rate*Hazard Ratio** (95% CI)
<1803.71.0 (reference)4.31.0 (reference)
180-1994.61.1 (0.6-1.9)8.22.3 (1.0-5.6)
200-2196.21.5 (0.9-2.4)7.82.4 (1.0-5.5)
220-2394.01.0 (0.6-1.6)9.02.4 (1.0-5.5)
249-2594.00.9 (0.5-1.6)11.23.6 (1.6-8.3)
260+9.71.9 (1.2-3.0)11.62.9 (1.3-6.5)
*

age-sex adjusted/1000 person -years

**

multivariate adjusted

Glucose < 110 mg/dlGlucose >= 110 mg/dl or Hx Diabetes
Cholesterol (mg/dl)IHD rate*Hazard Ratio** (95% CI)IHD rate*Hazard Ratio** (95% CI)
<1803.71.0 (reference)4.31.0 (reference)
180-1994.61.1 (0.6-1.9)8.22.3 (1.0-5.6)
200-2196.21.5 (0.9-2.4)7.82.4 (1.0-5.5)
220-2394.01.0 (0.6-1.6)9.02.4 (1.0-5.5)
249-2594.00.9 (0.5-1.6)11.23.6 (1.6-8.3)
260+9.71.9 (1.2-3.0)11.62.9 (1.3-6.5)
Glucose < 110 mg/dlGlucose >= 110 mg/dl or Hx Diabetes
Cholesterol (mg/dl)IHD rate*Hazard Ratio** (95% CI)IHD rate*Hazard Ratio** (95% CI)
<1803.71.0 (reference)4.31.0 (reference)
180-1994.61.1 (0.6-1.9)8.22.3 (1.0-5.6)
200-2196.21.5 (0.9-2.4)7.82.4 (1.0-5.5)
220-2394.01.0 (0.6-1.6)9.02.4 (1.0-5.5)
249-2594.00.9 (0.5-1.6)11.23.6 (1.6-8.3)
260+9.71.9 (1.2-3.0)11.62.9 (1.3-6.5)
*

age-sex adjusted/1000 person -years

**

multivariate adjusted

ischemic heart disease, serum cholesterol, serum glucose
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© American Journal of Hypertension, Ltd. 2001
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