Dysglycaemia and incident aortic stenosis: a cohort study

Background Aortic stenosis is a degenerative condition with high mortality in its severe stages and no preventive treatment. While diabetes is a known risk factor, the role of elevated glucose levels below the diabetic threshold in the development of aortic stenosis remains unclear. This study investigated the association between dysglycaemia, including impaired fasting glucose, and the incidence of aortic stenosis. Methods This study included 324 449 participants from the Swedish Apolipoprotein Mortality Risk cohort (1985–1996) who were free of aortic valve disease at baseline and had fasting glucose and lipid levels recorded. Participants were followed for incident aortic stenosis through the National Patient and Cause of Death Registers until 31 December 2020. Fasting glucose was categorised into low (<3.9 mmol/L), normal (3.9–6.0 mmol/L), impaired fasting glucose (6.1–6.9 mmol/L), high glucose (≥7.0 mmol/L) and diabetes. HRs were calculated using Cox proportional hazards models, with adjustments for age, sex, lipids, socioeconomic status, hypertension and kidney disease. Results Over a mean follow-up of 25.9 years, 8523 participants developed aortic stenosis. Compared with normal glucose levels, adjusted HRs were 0.96 (95% CI 0.82 to 1.13) for low glucose, 1.36 (95% CI 1.24 to 1.50) for impaired fasting glucose, 1.79 (95% CI 1.60 to 1.99) for high glucose and 2.21 (95% CI 1.80 to 2.73) for diabetes. Spline analysis indicated a continuous increase in risk with rising glucose levels, even below the impaired fasting glucose threshold. Conclusions Dysglycaemia, including glucose levels below the diabetic range, is associated with a higher risk of aortic stenosis.