Management of Elevated Cholesterol in the primary prevention Group of Adult Japanese (MEGA) Study assists the view that a fasting plasma glucose level ≥100 mg/dL increases cardiovascular risk

Naoko Tajima, Hideaki Kurata, Yasuo Ohashi, Kyoichi Mizuno, Haruo Nakamura, Naoko Tajima, Hideaki Kurata, Yasuo Ohashi, Kyoichi Mizuno, Haruo Nakamura

Abstract

Aims/Introduction: To evaluate the relationship between fasting plasma glucose (FPG) level and cardiovascular disease in patients with hypercholesterolemia, and to evaluate the effect of pravastatin on risk reduction in a post-hoc analysis of the large-scale Management of Elevated Cholesterol in the primary prevention Group of Adult Japanese (MEGA) Study.

Materials and methods: A total of 7832 patients were randomized to diet alone or diet plus low-dose pravastatin (10-20 mg/day, average 8.3 mg during follow-up periods) and followed for >5 years. In this analysis, the relationship between FPG and risk of cardiovascular disease events over 5 years were studied in 6673 patients with recorded baseline FPG levels by using the multivariable Cox proportional hazards model with the restricted quadratic spline based on three knots for FPG quartiles.

Results: The spline curve showed an obvious sharp increased risk from a FPG of ≥100 mg/dL. The spline curve in the diet plus pravastatin group was consistently lower than in the diet group, regardless of the FPG level.

Conclusions: The risk of cardiovascular disease appears to increase when FPG is ≥100 mg/dL, with a sharp increased risk found above this level in patients with hypercholesterolemia. Statin treatment seems to be beneficial to reduce cardiovascular disease risk in this population. This trial was registered with ClinicalTrials.gov (no. NCT00211705). (J Diabetes Invest, doi: 10.1111/j.2040-1124.2011.00121.x, 2011).

Keywords: Cardiovascular risk; Fasting plasma glucose; Randomized controlled trial.

Figures

Figure 1
Figure 1
(a) The restricted quadratic spline curve for cardiovascular disease according to levels of fasting plasma glucose (FPG), based on three knots for FPG quartiles. (b–d) Sensitivity analysis: (b) two knots by tertile points, (c) four knots by quintile points, and (d) three knots by FPG 90, 100 and 110 mg/dL. Dashed lines, corresponding 95% confidence intervals.
Figure 2
Figure 2
The spline curves for (a) coronary heart disease and (b) stroke according to fasting plasma glucose (FPG). The knots are quartiles of the FPG in the whole group.
Figure 3
Figure 3
The spline curves for cardiovascular disease according to levels of fasting plasma glucose (FPG) for each treatment arm. The knots are the quartiles of the FPG in the whole group. Black lines are the diet group and red lines are the diet plus pravastatin group (solid lines). Dashed lines, corresponding 95% confidence intervals.

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Source: PubMed

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