Global and regional mortality from ischaemic heart disease and stroke attributable to higher-than-optimum blood glucose concentration: comparative risk assessment

SummaryBackgroundCardiovascular mortality risk increases continuously with blood glucose, from concentrations well below conventional thresholds used to define diabetes. We aimed to quantify population-level effects of all higher-than-optimum concentrations of blood glucose on mortality from ischaemic heart disease and stroke worldwide.MethodsWe used population distribution of fasting plasma glucose to measure exposure to higher-than-optimum blood glucose. We collated exposure data in 52 countries from individual-level records in population health surveys, systematic reviews, and data provided by investigators. Relative risks for ischaemic heart disease and stroke mortality were from a meta-analysis of more than 200 000 participants in the Asia-Pacific region, with adjustment for other cardiovascular risk factors.ResultsIn addition to 959 000 deaths directly assigned to diabetes, 1 490 000 deaths from ischaemic heart disease and 709 000 from stroke were attributable to high blood glucose, accounting for 21% and 13% of all deaths from these conditions. 1·8 million of these 2·2 million cardiovascular deaths (84%) were in low-and-middle-income countries (1 224 000 for ischaemic heart disease, 623 000 for stroke). 792 000 (53%) of deaths from ischaemic heart disease and 345 000 (49%) from stroke that were attributable to high blood glucose were in men. Largest numbers of deaths attributable to this risk factor from ischaemic heart disease were in low-and-middle-income countries of South Asia (548 000) and Europe and Central Asia (313 000), and from stroke in South Asia (215 000) and East Asia and Pacific (190 000).InterpretationHigher-than-optimum blood glucose is a leading cause of cardiovascular mortality in most world regions. Programmes for cardiovascular risk and diabetes management and control at the population level need to be more closely integrated.