Article Text

Casual blood glucose and subsequent cardiovascular disease and all-cause mortality among 159 731 participants in Cohort of Norway (CONOR)
  1. Hilde Kristin Refvik Riise1,
  2. Jannicke Igland2,
  3. Gerhard Sulo3,4,
  4. Marit Graue1,
  5. Johannes Haltbakk1,
  6. Grethe Seppola Tell2,5,
  7. Marjolein Memelink Iversen1
  1. 1Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Vestlandet, Norway
  2. 2Department of Global Public Health and Primary Care, University of Bergen, Bergen, Vestlandet, Norway
  3. 3Centre for Disease Burden, Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Vestlandet, Norway
  4. 4Oral Health Centre of Expertise in Western Norway, University of Bergen, Bergen, Vestlandet, Norway
  5. 5Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Vestlandet, Norway
  1. Correspondence to Dr Hilde Kristin Refvik Riise; hkrr{at}


Introduction Our aim was to assess the association between casual blood glucose level and subsequent cardiovascular disease (CVD) and mortality among community-dwelling adults without a diagnosis of diabetes.

Research design and methods In this community-based cohort study, 159 731 individuals with a measurement of casual blood glucose were followed from their participation date in Cohort of Norway (CONOR) (1994–2003) until a CVD episode, death or 31 December 2009. All analyses were done using Cox proportional hazard regression, and the results are reported as multivariable-adjusted HRs with 95% CI.

Results Compared with those with normal glucose levels (<7.8 mmol/L), participants categorized as having borderline (7.8–11.0 mmol/L) levels showed an increased risk of a stroke (HR 1.29; 95% CI 1.12 to 2.49) and cardiovascular (HR 1.29; 95% CI 1.12 to 2.48), and all-cause (HR 1.27; 95% CI 1.16 to 1.38) mortality, while participants with high glucose levels (>11.0 mmol/L) had an even more increased risk. One mmol/L increase in glucose level was associated with an increased risk of all four endpoints among participants with borderline as well as within normal glucose levels. In analyses stratified by sex and age group, the CVD risk estimates tended to be higher in women than in men and in those <65 years of age but no significant interactions were found.

Conclusion An increase in casual blood glucose levels, even within the range of normal and borderline levels, was positively associated with increased risk of CVD and mortality among community-dwelling adults without a known diagnosis of diabetes.

  • glucose
  • cardiovascular system
  • risk factors

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  • Contributors HKRR is the guarantor of this work and takes responsibility for the accuracy of the data analysis. HKRR also researched data and wrote the manuscript. JI acquired and facilitated data, researched data and reviewed/edited the manuscript. GS, MG and JH reviewed/edited the manuscript. GST acquired and facilitated data and reviewed/edited the manuscript. MMI was the principal investigator for the project, applied for approval from the regional committees and reviewed/edited the manuscript. The research idea was formulated by MMI, GST, MG, JI and JH.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer This study used data from the Norwegian Cause of Death Registry. The interpretation and reporting of these data are the sole responsibility of the authors, and no endorsement by the Norwegian Cause of Death Registry is intended, nor should be inferred.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Regional Committee for Medical and Health Research Ethics (2015/2045). All Cohort of Norway survey participants signed a written informed consent to research and linkage of their data to health registries.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. The data and study material will not be made available to other researchers for purposes of reproducing the results or replicating the procedure by reason of ethical and data protective legislation.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.