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.