Predicting Future Cardiovascular Disease Do we need the oral glucose tolerance test?

University of Texas at San Antonio, San Antonio, Texas, United States
Diabetes Care (Impact Factor: 8.42). 11/2002; 25(10):1851-6. DOI: 10.2337/diacare.25.10.1851
Source: PubMed


Our objective was to compare the performance of oral glucose tolerance tests (OGTTs) and multivariate models incorporating commonly available clinical variables in their ability to predict future cardiovascular disease (CVD).
We randomly selected 2,662 Mexican-Americans and 1,595 non-Hispanic whites, 25-64 years of age, who were free of both CVD and known diabetes at baseline from several San Antonio census tracts. Medical history, cigarette smoking history, BMI, blood pressure, fasting and 2-h plasma glucose and serum insulin levels, triglyceride level, and fasting serum total, LDL, and HDL cholesterol levels were obtained at baseline. CVD developed in 88 Mexican-Americans and 71 non-Hispanic whites after 7-8 years of follow-up. Stepwise multiple logistic regression models were developed to predict incident CVD. The areas under receiver operator characteristic (ROC) curves were used to assess the predictive power of these models.
The area under the 2-h glucose ROC curve was modestly but not significantly greater than under the fasting glucose curve, but both were relatively weak predictors of CVD. The areas under the ROC curves for the multivariate models incorporating readily available clinical variables other than 2-h glucose were substantially and significantly greater than under the glucose ROC curves. Addition of 2-h glucose to these models did not improve their predicting power.
Better identification of individuals at high risk for CVD can be achieved with simple predicting models than with OGTTs, and the addition of the latter adds little if anything to the predictive power of the model.

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    • "As people with normal fasting glucose can also have elevated TGs and other cardiometabolic risk factors (13,14), it is reasonable to assume that those with higher TGs and other cardiometabolic risk factors may have a greater risk of developing IFG. Elevated TGs have been used in diabetes risk prediction models (15–18), but little is known about whether elevated TG levels also increase the risk for IFG independently of central obesity, HDL-C, and elevated blood pressure (BP). "
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    ABSTRACT: OBJECTIVE Elevated plasma triglycerides (TGs) have been included in diabetes risk prediction models. This study examined whether elevated TGs predict risk for impaired fasting glucose (IFG).RESEARCH DESIGN AND METHODS This study used the baseline and longitudinal follow-up data from the Multi-Ethnic Study of Atherosclerosis (MESA). The analysis included non-Hispanic whites, African Americans, Hispanics, and Chinese Americans 45-84 years of age who had fasting glucose <100 mg/dL at baseline, and who did not have clinically evident cardiovascular disease or diabetes. Cox proportional regression models were used to examine the association of elevated TGs with incidence of IFG adjusting for central obesity, low HDL cholesterol, elevated blood pressure, baseline fasting glucose, and BMI. Area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of elevated TGs in predicting IFG were calculated.RESULTSThe incidence rate of developing IFG was 59.1 per 1,000 person-years during the median 4.75 years of follow-up. African Americans and Hispanics had a higher incidence rate of IFG compared with non-Hispanic whites among people with normal TG concentrations. Elevated TGs (>150 mg/dL) at baseline were independently associated with the incidence of IFG with an adjusted hazard ratio of 1.19 (95% CI 1.04-1.37). However, its predictive value for identifying people at risk for IFG was poor, with <57% AUC. Interactions of elevated TGs with race/ethnicity in predicting IFG were not statistically significant.CONCLUSIONS Elevated TGs were moderately associated with risk for IFG, and it was a poor risk prediction tool for IFG.
    Diabetes care 10/2012; 36(2). DOI:10.2337/dc12-0355 · 8.42 Impact Factor
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    Acta clinica Belgica 09/2003; 58(5):269-76. DOI:10.1179/acb.2003.58.5.001 · 0.59 Impact Factor
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    ABSTRACT: T he substantial burden of morbidity and mortality associated with type 2 diabetes and the high costs associated with the management of diabetic complications highlight the need for the development of strategies for the prevention of diabetes. Impaired glucose tolerance is a pre-diabetic state which may present an opportunity for intervention to prevent the onset of clinical diabetes. Four recent clinical trials, the DPP, the FDPS, the STOP-NIDDM and the Da Qing study, have evaluated interventions based on diet and exercise and/or pharmacotherapy in pre-diabetic subjects. In all these trials the intervention strategies significantly reduced the incidence of diabetes. A worldwide epidemic of type 2 diabetes will occur over the coming decades and translating the results of these studies into practical and effective initiatives for diabetes prevention is an urgent clinical priority. Br J Diabetes Vasc Dis 2003;3(suppl 1):S6-S11
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