***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE Glucose intolerance is a risk factor for coronary disease , but there is uncertainty about the shape of the dose-response relationship between glucose level and risk of coronary mortality . We examined the prospect i ve relation of 2-h postload blood glucose ( 2hBG ) with coronary and other major causes of mortality over 33 years . RESEARCH DESIGN AND METHODS A 50-g oral glucose tolerance test ( OGTT ) was performed at baseline ( 1967 - 1969 ) in 17,869 male civil servants aged 40 - 64 years . RESULTS There were 3,561 coronary deaths during 451,787 person-years of observation . All-cause , cardiovascular , and respiratory mortality were elevated among participants with glucose intolerance . The hazard of coronary mortality rose from 2hBG = 4.6 mmol/l ( 83 mg/dl [ 95 % CI 4.2 - 5.3 ] ) . The dose-response relation was best fitted by a single slope above this level , with no evidence of nonlinearity , compared with Cox models using other threshold levels , and those containing log 2hBG terms . There was no evidence for a dose-response relationship below 2hBG = 4.6 mmol/l . Between this level and 11.1 mmol/l ( 200 mg/dl ) , the age-adjusted hazard ratio was 3.62 ( 95 % CI 2.3 - 5.6 ) . The grade d relationship was attenuated by 45 % after adjustment for baseline coronary heart disease ( CHD ) , BMI , systolic blood pressure , blood cholesterol , smoking , physical activity , lung function , and employment grade . CONCLUSIONS A threshold model with linear slope best described the dose-response relationship between postload blood glucose and CHD mortality risk We have examined the risk of  subsequent ischemic heart disease ( IHD ) in men according to their initial fasting plasma glucose level in a prospect i ve cohort study ( Caerphilly Collaborative Study ) of 4860 middle aged men from South Wales and Bristol , U.K. Ninety-four men reported themselves to be diabetic at initial screening and fasting venous plasma glucose levels were determined in these men and in a further 4519 non-diabetic men . At follow-up new IHD events occurred twice as commonly in diabetics compared to non-diabetics and overall mortality was increased 4-fold . Among non-diabetics however , increased IHD events only occurred in men with fasting values at the upper end of the distribution of baseline plasma glucose values [ at 6.8 mmol/l ( 122 mg/dl ) or more ] . This association was reduced , but remained statistically significant , after adjusting for factors associated with plasma glucose levels ; body mass index , plasma triglyceride , smoking habit and pre-existing IHD . In conclusion there is no evidence of a consistent , grade d increase in risk of IHD by initial fasting plasma glucose level although the risk is significantly increased in men with baseline plasma values at 6.8 mmol/l ( 122 mg/dl ) or more , and also in diabetics . This study suggests that such levels probably represent a pre-diabetic state in many individuals . Appropriate non-pharmacological intervention may be useful in halting the progression to the diabetic state , although this should be tested in experimental studies OBJECTIVE Our objective was to compare the performance of oral glucose tolerance tests ( OGTTs ) and multivariate models incorporating commonly available clinical variables in their ability to predict future cardiovascular disease ( CVD ) . RESEARCH DESIGN AND METHODS We r and omly selected 2,662 Mexican-Americans and 1,595 non-Hispanic whites , 25 - 64 years of age , who were free of both CVD and known diabetes at baseline from several San Antonio census tracts .  Medical history , cigarette smoking history , BMI , blood pressure , fasting and 2-h plasma glucose and serum insulin levels , triglyceride level , and fasting serum total , LDL , and HDL cholesterol levels were obtained at baseline . CVD developed in 88 Mexican-Americans and 71 non-Hispanic whites after 7 - 8 years of follow-up . Stepwise multiple logistic regression models were developed to predict incident CVD . The areas under receiver operator characteristic ( ROC ) curves were used to assess the predictive power of these models . RESULTS The area under the 2-h glucose ROC curve was modestly but not significantly greater than under the fasting glucose curve , but both were relatively weak predictors of CVD . The areas under the ROC curves for the multivariate models incorporating readily available clinical variables other than 2-h glucose were substantially and significantly greater than under the glucose ROC curves . Addition of 2-h glucose to these models did not improve their predicting power . CONCLUSIONS Better identification of individuals at high risk for CVD can be achieved with simple predicting models than with OGTTs , and the addition of the latter adds little if anything to the predictive power of the model OBJECTIVE The associations between glucose intolerance measured at the study entry date and the 23-year incidence of coronary heart disease ( CHD ) , CHD mortality , and total mortality were examined at the Honolulu Heart Program . RESEARCH DESIGN AND METHODS This prospect i ve study followed a cohort of 8,006 Japanese-American men who were 45 - 68 years old and living on the isl and of Oahu , HI , in 1965 .  Baseline glucose was measured in a nonfasting state 1 h after a 50-g glucose load . History and use of medication for diabetes was obtained during an interview . The cohort was divided into four categories of glucose tolerance : low-normal , high-normal , asymptomatic hyperglycemia , and known diabetes . RESULTS During the 23 years of follow-up , 864 incident cases of CHD , 384 deaths from CHD , and 2,166 total deaths occurred . The relative risks ( RRs ) were obtained using Cox proportional hazards modeling , with the low-normal category as a reference . The RRs were adjusted for age only , as well as for age , BMI , hypertension , cholesterol , triglycerides , smoking , alcohol , and a Japanese diet index . The age-adjusted and risk factor-adjusted RRs for all outcomes were significant for the asymptomatic hyperglycemic and known diabetes groups ( P<0.05 ) . The age-adjusted RRs for CHD incidence and total mortality were marginally significant in the high-normal group , but the RRs were not significant when adjusted for risk factors . CONCLUSIONS These results suggest a dose-response relation of glucose intolerance at baseline with CHD incidence , CHD mortality , and total mortality , independent of other risk factors , in this cohort of middle-aged and older Japanese-American men Recent studies have reported no association between elevated glycated hemoglobin ( HbA(1c ) ) and incident cardiovascular disease ( CVD ) among women without diabetes . This study describes associations between HbA(1c ) and new onset  CVD  in a representative adult population cohort . Assessment of participants in The North West Adelaide Health Study ( NWAHS ) , a population study of r and omly selected adults ( age > or = 18 years , n = 4,060 ) , included measurement of height , weight , blood pressure , fasting lipids , glucose , and HbA(1c ) . A self-completed question naire assessed doctor-diagnosed diabetes , CVD and stroke , smoking status , and demographics . The cohort was followed for an average 3.5 years . Of the 2,913 adults free of diabetes at baseline and follow-up , 94 ( 3.5 % ) reported new onset coronary heart disease ( CHD ) and /or stroke . Compared with those with an HbA(1c ) < or = 5.0 % , risk of new onset CVD was increased in those with HbA(1c ) 5.4 - 5.6 % ( odds ratio ( OR ) 2.5 , 95 % confidence interval ( CI ) 1.4 , 4.6 ) , and > or = 5.7 % ( OR 1.9 , 95 % CI 1.1 , 3.4 ) , after adjustment for other risk factors . The association was stronger in women than men ( P = 0.03 ) , and attenuated to only a small degree by addition of impaired fasting glucose ( IFG ) , hypertension , hypercholesterolemia , BMI , waist circumference , or smoking to the model . Elevated HbA(1c ) is related to new onset CVD over a relatively short follow-up period in both men and women without diabetes and who do not develop diabetes , after adjustment for other major risk factors . Unlike previous studies , this relationship was not substantially attenuated by other traditional risk factors Objective : Most historical studies of cardiorespiratory risk factors as predictors of mortality have been based on men . This study examines whether they predict mortality over long periods in women and men . Design : Prospect i ve cohort study . Setting : Participants were employees of the General Post Office . Methods : Risk factor data were collected via clinical examination and question naire , 1966–7 . Associations between cardiorespiratory risk factors and  40-year mortality  were determined for 644 women and 1272 men aged 35–70 at examination . Main outcome measures : All-cause , cardiovascular ( CVD ) , cancer and respiratory mortality . Results : Associations between systolic blood pressure and all-cause and stroke mortality were equally strong for women and men , hazard ratio ( 95 % confidence interval ) 1.25 ( 1.1 to 1.4 ) and 1.18 ( 1.1 to 1.3 ) ; and 2.17 ( 1.7 to 2.8 ) and 1.69 ( 1.4 to 2.1 ) , respectively . Cholesterol was higher in women and was associated with all-cause 1.22 ( 1.1 to 1.4 ) and CVD 1.39 ( 1.2 to 1.7 ) mortality , while associations between 2-hour glucose and all-cause 1.15 ( 1.1 to 1.2 ) , coronary heart disease ( CHD ) 1.25 ( 1.1 to 1.4 ) and respiratory mortality 1.21 ( 1.0 to 1.5 ) were observed in men . Obesity was associated with stroke in women ( 2.42 ( 1.12 to 5.24 ) ) and CHD in men ( 1.59 ( 1.02 to 2.49 ) ) , while ECG ischaemia was associated with CVD in both sexes . The strongest , most consistent predictor of mortality was smoking in women and poor lung function in men . However , evidence of sex differences in associations between the cardiorespiratory risk factors measured and mortality was sparse . Conclusions : Data from a 40-year follow-up period show remarkably persistent associations between risk factors and cardiorespiratory and all-cause mortality in women and men In prospect i ve studies , disease rates during follow-up are typically analyzed with respect to the values of factors measured during an initial baseline survey . However , because of " regression dilution , " this generally tends to underestimate the real associations of disease rates with the " usual " levels of such risk factors during some particular exposure period . The " regression dilution ratio " describes the ratio of the steepness of the uncorrected association to that of the real association . To assess the relevance of the usual value of a risk factor during particular exposure periods ( e.g. , first , second , and third decades ) to disease risks , regression dilution ratios can be derived by relating baseline measurements of the risk factor to replicate measurements from a reasonably representative sample of study participants after an interval equivalent to about the midpoint of each exposure period ( e.g. , at 5 , 15 , and 25 years , respectively ) . This report illustrates the impact of this time interval on the magnitude of the regression dilution ratios for blood pressure and blood cholesterol . The analyses were based on biennial re measurements over 30 years for participants in the Framingham Study ( Framingham , Massachusetts ) and a 26-year resurvey for a sample of men in the Whitehall Study ( London , Engl and ) . They show that uncorrected associations of disease risk with baseline measurements underestimate the strength of the real associations with usual levels of these risk factors during the first decade of exposure by about one-third , the second decade by about one-half , and the third decade by about two-thirds . Hence , to correct appropriately for regression dilution , replicate measurements of such risk factors may be required at varying intervals after baseline for at least a sample of participants Background Ischaemic heart disease is a global priority of health-care policy , because of its social repercussions and its impact on the health-care system . Yet there is little information on coronary morbidity in Spain and on the effect of the principal risk factors on risk of coronary heart disease . The objective of this study is to describe the epidemiology of coronary disease ( incidence , mortality and its association with cardiovascular risk factors ) using the information gathered by primary care practitioners on cardiovascular health of their population . Methods A prospect i ve study was design ed . Eight primary -care centres participated , each contributing to the constitution of the cohort with the entire population covered by the centre . A total of 6124 men and women aged over 25 years and free of cardiovascular disease agreed to participate and were thus enrolled and followed-up , with all fatal and non-fatal coronary disease episodes being registered during a 5-year period . Repeated measurements were collected on 
    Output:
    
In the Reykjavik Study and a meta- analysis of other Western prospect i ve studies , fasting and post-load glucose levels were modestly associated with CHD risk in people without diabetes .
The meta- analysis suggested a somewhat stronger association between HbA(1c ) levels and CHD risk