Fasting Plasma Glucose and Incident Heart Failure Risk: A Population-Based Cohort Study and New Meta-analysis

• Fasting glucose is positively associated with risk of heart failure in nondiabetics
• The association is continuous and independent of established risk factors
• The association is consistent in several clinical subgroups
• Fasting glucose levels may help identify persons at risk of heart failure
• Further work is needed to investigate causality of findings

BackgroundThere remains uncertainty regarding the association between fasting plasma glucose (FPG) and risk of heart failure (HF) in individuals without a history of diabetes.Methods and ResultsWe assessed the association between FPG and HF risk in a population-based cohort of 1,740 men aged 42-61 years who were free from HF or diabetes at baseline. During a mean follow-up of 20.4 years, 146 participants developed HF. In age-adjusted analysis, the hazard ratio (HR) for HF per 1 mmol/L increase in FPG was 1.34 (95% confidence interval 1.22–1.48). This association persisted after adjusting for established HF risk factors: HR 1.27, 95% confidence interval 1.14–1.42. The findings remained consistent across several clinical subgroups and in analyses excluding incident coronary heart disease or diabetes during follow-up. In a meta-analysis of 10 prospective studies involving 4,213 incident HF cases, the HR for HF per 1 mmol/L increase in FPG level was 1.11 (95% confidence interval 1.04–1.17), with evidence of heterogeneity between studies (I2 = 79%; 95% confidence interval 63%–89%; P < .001). The corresponding HR was 1.12 (95% confidence interval 1.08–1.18) on exclusion of the single study that accounted for the heterogeneity.ConclusionsThere exists a positive, continuous, and independent association between FPG and risk for HF. Studies are warranted to evaluate the causal relevance of these findings.