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Metabolism and Metabolomics

Association of fasting plasma glucose trajectory with lifetime risk of cardiovascular disease



Few studies have used multiple measurements of fasting plasma glucose (FPG) to examine the impact of long-term FPG trajectory patterns on lifetime risk of cardiovascular disease (CVD). We aimed to identify the long-term patterns in FPG trajectories and to estimate the lifetime risk of CVD according to FPG trajectories.


Individuals free of CVD at index ages 35 (n = 72,324), 45 (n = 62,049), and 55 (n = 38,113) years were included. FPG concentrations were measured in 2006, 2008, and 2010. The FPG trajectories were identified by latent mixture modeling. The modified Kaplan-Meier method was used to calculate lifetime risk of CVD.


We identified five distinct FPG trajectories and named them according to FPG range and changing pattern over time: low-stable, moderate-stable, moderate-increasing, elevated-decreasing, and elevated-stable. At index age 35 years, we documented 3110 CVD events in men during 371,219 person-years of follow-up and 357 CVD events in women during 107,447 person-years of follow-up. Among all participants, the elevated-stable FPG pattern experienced the highest lifetime risk of CVD (44.8%, 95% CI: 37.8–51.9%), low-stable pattern was lowest (24.3%, 95% CI: 23.3–25.2%). At index age 55 years, although the elevated-stable and elevated-decreasing FPG patterns had similar original FPG concentrations, individuals with elevated-decreasing pattern (30.0%, 95% CI: 23.9–36.1%) had approximately one-third less lifetime risk of CVD than those with elevated-stable pattern (43.6%, 95% CI: 31.8–55.3%).


FPG trajectories were significantly associated with the lifetime risk of CVD. Both decrease in FPG over time and consistently lower FPG over 4 years were associated with lower lifetime risk of CVD.

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Fig. 1: Trajectory of fasting plasma glucose (FPG) for all participants during 2006–2010.
Fig. 2: Cumulative incidence of CVD adjusted for the competing risk of death for all participants according to FPG trajectories at index ages 35, 45, and 55 years.

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.


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Authors and Affiliations



LS, DL, YT, and SW conceived the study. LS, DL, YT, SW, and YW contributed to the study design. SW and SC prepared and cleaned the data. LS, LW, DL, and YY conducted the data analysis. DL, LS and YT drafted the manuscript. LS, DL, YT, SW, YW, and YH critically revised the manuscript for important intellectual content. All authors approved the final version of the manuscript. YT and SW act as guarantors.

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Correspondence to Shouling Wu or Yaohua Tian.

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Li, D., Song, L., Wang, L. et al. Association of fasting plasma glucose trajectory with lifetime risk of cardiovascular disease. Eur J Clin Nutr (2022).

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