Review Article

An Overall Glance of Evidence Supportive of One-Hour and Two-Hour Postload Plasma Glucose Levels as Predictors of Long-Term Cardiovascular Events

Table 1

Epidemiological studies describing the postprandial hyperglycemia as a predictor of cardiovascular mortality in various parts of the world for the last two decades.

No.Type of studyName of the studyTotal number of patientsDuration of follow-up (years)Subject characteristicsStudy outcome measuredRate ratio95% CI value

1Prospective cohortSievers et al., 1999 [11]174510.6Pima Indians with type 2 diabetes ≥15 years of age2-hour postprandial glucose (2 hPG) levels were associated with death rate from cardiovascular disease (CVD)Death rate 1.21.1–1.40.007

2Prospective cohortde Vegt et al., 1999 [12]23638Dutch subjects 50–75 years without known diabetesPostload glucose predictive of increased cardiovascular mortality even within the nondiabetic rangeRelative risk (RR) 3.41.35–8.53<0.05

3Prospective cohortMeigs et al., 2002 [13]33704Subjects from the Framingham offspring study without clinical CVD or medication-treated diabetes2 hPG is associated with cardiovascular eventsRR 1.141.02–1.27Not available

4Prospective cohortBrunner et al., 2006 [14]1786933London-based male civil servants aged 40–64 years excluding those with known diabetes and with missing glucose measurements2 hPG associated with coronary heart diseaseHazard ratio (HR) 3.622.34–5.56Not available

5Prospective cohortMeisinger et al., 2006 [15]116030Randomly selected 40–59 year non-diabetic German subjects1-hour postload glucose (1 hPG) associated with all-cause mortalityHR 1.491.17–1.88Not available

6Prospective cohort (1974–1979)Nigam et al., 2007 [16]169114.7Patients with coronary artery disease (CAD) who were enrolled at 15 centers throughout North AmericaPostprandial hyperglycemia was not associated with cardiovascular mortality in patients with undiagnosed diabetesHR 0.890.59–1.36Not available

7Prospective cohortChien et al., 2008 [17]216510.5Chinese subjects in Taiwan aged ≥35 yearsPostchallenge glucose was associated with major cardiovascular eventsRR 2.051.23–3.42≤0.001

8Prospective cohortSarwar et al., 2010 [18]1856923.5Iceland subjects without history of diabetes and myocardial infarction (MI)Postload glucose associated with coronary heart diseaseHR 1.031.01–1.05Not available
9Meta-analysis of 26 western prospective cohort studiesSarwar et al., 2010 [18]12652Not applicableNot applicablePostload glucose associated with coronary heart diseaseRR 1.051.03–1.07Not available

10Prospective cohortKitada et al., 2010 [19]4222Acute MI (AMI) Japanese patients2 hPG was the only independent predictor of long-term major adverse cardiovascular events (MACE) two years after AMIOdds ratio (OR) 1.851.07–3.210.028

11Case controlShimabukuro et al., 2011 [20]287Not applicableJapanese who visited the university hospital to be checked for glucose intolerance or known type 2 diabetes were consecutively recruitedLeft ventricle dysfunction associated with impaired glucose toleranceOR 3.431.09–11.20.037

12Prospective cohort (HEART2D trial)Raz et al., 2011 [21]11152.7Patients with type 2 diabetes who survived of AMIPatients using insulin targeting the postprandial versus fasting hyperglycemia had lower cardiovascular eventsHR 0.690.49–0.960.029

13Large prospective cohort (EpiDREAM study)Anand et al., 2012 [22]18,9903.530–85 years multiethnic patients from 21 countries who had impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) levels2-hour post-OGTT glucose associated with increase in risk of cardiovascular events or deathHR 1.171.13–1.22Not available

14Prospective cohortTamita et al., 2012 [23]2755.3Japanese subjects with AMIAbnormal glucose tolerance associated with MACEHR 2.651.37–5.150.004

15Prospective cohortFurtado de Souza et al., 2012 [24]14836 ± 14 monthsBrazilian subjects undergoing diabetes screening attending a primary care unit2-hour OGTT results were associated with CVDOR 1.0131.002–1.0250.024
169 Finnish and Swedish prospective cohortNing et al., 2012 [25]3743 men and 3916 women16.425 to 90 years who had fasting plasma glucose (FPG) < 6.1 mmol/l and 2 h PG < 7.8 mmol/l and free of CVD2 hPG associated with coronary heart diseaseHR 1.13 in men; 1.33 in women0.93–1.37 in men; 0.83–2.13 in womenNot available

17Prospective cohortHenareh and Agewall, 2012 [26]1236.03 ± 1.36Swedish subjects aged 31–80 years who had suffered a previous MI2 hPG was a significant predictor of cardiovascular death, recurrent MI, and unstable angina pectorisHR 1.271.00–1.62<0.05

18Prospective cohortSilbernagel et al., 2012 [27]17727.7 ± 2.0German nondiabetic subjects who were referred for angiography and whose FPG was <126 mg/dl underwent OGTTPostchallenge glucose undetected by fasting glucose and glycated hemoglobin independently predicted the cardiovascular mortalityHR 1.571.02–2.430.041

19Cross sectional (second strong heart study)Capaldo et al., 2013 [28]562Not applicableAmerican nondiabetic and nonhypertensive Indians of 45–74 years of ageBoth higher IFG and IGT levels rather than only IFG associated with left ventricular hypertrophyOR 9.762.03–46.790.004

20Prospective cohortBarzin et al., 2013 [29]37948Tehran urban subjects aged ≥40 years without history of diabetes or CVDIsolated postchallenge hyperglycemia associated with cardiovascular eventsHR 1.771.19–2.640.005

21Cross sectionalYang et al., 2013 [30]6040Not applicableChinese prediabetic subjectsCVD events associated with IGT levels compared to IFG levelsOR 2.881.36–6.010.0059

22Prospective cohortKuramitsu et al., 2013 [31]8284.3Japanese patients of stable angina undergoing percutaneous intervention (PCI)Postchallenge hyperglycemia was associated with MACEHR 1.621.07–2.530.023

23Finnish diabetes prevention prospective cohort studyLind et al., 2014 [32]50413Finnish individuals with IGT were followed up with yearly OGTT, FPG, and HbA1c2 hPG was associated with CVD eventsHR 2.191.51–3.18≤0.001
24Prospective cohortRitsinger et al., 2015 [33]167 AMI patients and 184 controls10Swedish patients up to 80 years with AMI (n = 167) and healthy controls (n = 184) with no previously known diabetesPatient with AMI having abnormal glucose tolerance after an OGTT performed at the time of discharge had higher cardiovascular mortalityHR 2.31.24–4.250.008

25aYorkshire retrospective cohortGeorge et al., 2015 [34]7683Patients without pre-existing diabetes mellitus post-MIIGT associated with increased incidence of MACEHR 1.541.06–2.240.024

25bYorkshire retrospective cohort studyGeorge et al., 2015 [34]7683Patients without pre-existing diabetes mellitus post-MINewly diagnosed diabetes associated with increased incidence of MACEHR 2.151.42–3.240.003

26Prospective cohortFaghihi-Kashani et al., 2016 [35]26077.2Patients of type 2 diabetes mellitus in Tehran2 hPG was associated with high incidence of coronary heart diseaseHR 1.641.03–2.61Not available

27Prospective cohortShahim et al., 2017 [36]4004224 European subjects aged ≥18–80 years hospitalized for a first or recurrent CAD event2 hPG associated with cardiovascular eventsHR 1.381.07–1.780.01

28Prospective cohortNielsen et al., 2017 [37]493427Swedish subjects without diabetes1 hPG predicted the cardiovascular deathHR 1.091.01–1.170.02

29Prospective cohortChattopadhyay et al., February 2018 [38]6744Post-MI survivors without known diabetes in England and WalesOnly 2 hPG predicted MACEHR 1.121.04–1.20≤0.001

30Retrospective cohortChattopadhyay et al., August 2018 [39]105640.8 monthsAcute coronary event survivors without known diabetes mellitus who had FBG and 2 hPG measured predischarge2 hPG independently predicted MACEHR 1.0911.043–1.142≤0.001

31Cross sectional (CATAMERI study)Fiorentino et al., 2019 [40]1010Not applicableNondiabetic Caucasian individuals with hbA1c <5.7%1 hPG during OGTT ≥ 155 mg/dl associated with CADOR 6.161.05–36.320.04

32Retrospective cohortChattopadhyay et al., 2019 [41]10562.8MI survivors in East yorkshire and North Lincolnshire2 hPG predicted MACE-free survivalHR 1.161.07–1.26≤0.001