Department of Internal Medicine, University of Tsukuba Institute of Clinical Medicine, 3-2-7 Miya-machi, Mito, Ibaraki, Japan.
J Atheroscler Thromb. 2012;19(4):385-96. doi: 10.5551/jat.10975. Epub 2012 Jan 11.
The post-challenge glucose (PCG) level has been suggested to be superior to the fasting blood glucose (FG) level for predicting the risk of future cardiovascular disease (CVD); however, the extent of its superiority has not been consistently shown among previous cohort studies. Therefore, we conducted a meta-analysis to summarize the quantitative association of FG and PCG with CVD risk and compared the strengths of the two associations.
Electronic literature searches using MEDLINE and EMBASE with an additional manual search were conducted for prospective observational studies of the association of FG and PCG with CVD risk. Studies were included if they were prospective studies in which the relative risk (RR) of CVD per 1 standard deviation increase in both FG and PCG could be estimated. Pooled relative risks for the incremental increase were calculated as RR(FG) and RR(PCG) using a bivariate random-effects model.
Data were obtained from 14 eligible studies that included 70,889 participants and 2,927 cases. The pooled RR(FG) and RR(PCG) (95% confidence interval) were, respectively, 1.15 (1.06 to 1.26) and 1.24 (1.12 to 1.36); the difference was significant (P =0.001). The association of PCG with CVD risk was stronger in studies that targeted participants with a baseline mean FG < 100 mg/dl (P < 0.001) or mean age ≥ 55 years (P =0.004).
Overall, the association of PCG with CVD risk was stronger than that of FG by approximately 50% on a log scale. Measuring PCG is especially important in populations with relatively low FG levels or in the elderly, although it is often burdensome in routine clinical practice.
与空腹血糖（FG）相比，负荷后血糖（PCG）水平被认为更能预测未来心血管疾病（CVD）的风险；然而，之前的队列研究并未一致显示其优势程度。因此，我们进行了一项荟萃分析，以总结 FG 和 PCG 与 CVD 风险的定量关联，并比较了这两种关联的强度。
使用 MEDLINE 和 EMBASE 进行电子文献检索，并进行了额外的手动搜索，以查找 FG 和 PCG 与 CVD 风险相关的前瞻性观察性研究。如果研究是前瞻性的，并且可以估计 FG 和 PCG 每增加一个标准差对 CVD 风险的相对风险（RR），则将其纳入研究。使用双变量随机效应模型计算增量增加的汇总相对风险，即 RR（FG）和 RR（PCG）。
从 14 项符合条件的研究中获得了数据，这些研究共纳入了 70889 名参与者和 2927 例病例。汇总的 RR（FG）和 RR（PCG）（95%置信区间）分别为 1.15（1.06 至 1.26）和 1.24（1.12 至 1.36）；差异具有统计学意义（P =0.001）。在针对基线 FG<100mg/dl 的参与者或平均年龄≥55 岁的研究中（P<0.001），PCG 与 CVD 风险的关联更强（P=0.004）。
总体而言，PCG 与 CVD 风险的关联比 FG 强约 50%（以对数尺度衡量）。在 FG 水平相对较低或老年人的人群中，测量 PCG 尤为重要，尽管它在常规临床实践中通常很繁琐。
