Population Health Research Institute

Exploring the link between glucose, heart attacks and stroke

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Diabetes is a strong independent risk factor for serious health outcomes including cardiovascular events, blindness, renal failure, amputations, chronic pain, steatohepatitis, cirrhosis, fractures, cognitive decline, and early death. Our epidemiologic research has shown that the risk for some of these consequences including cardiovascular outcomes and cognitive decline is not limited to people with diabetes and extends across the range of dysglycemia, from normal glucose levels, right into the diabetic range.


The Diabetes and Dysglycemia Program at the Population Health Research Institute is explicitly testing the effect of treating dysglycemia on several outcomes in ambulatory and hospitalized patients with a variety of therapies including subcutaneous insulin, intravenous insulin, omega 3 fatty acids, blood pressure lowering drugs, fibrates and statins. They also support ongoing epidemiologic studies related to identifying the genetic, physiologic, behavioural, anthropomorphic and social risk factors for dysglycemia; and ways of treating dysglycemia, restoring beta cell health, and preventing diabetes.


Main Publications

Gerstein HC, Yusuf S. Dysglycemia and risk of cardiovascular disease. Lancet 1996; 347(9006): 949-950.

Coutinho M, Gerstein HC, Wang Y, Yusuf S. The relationship between glucose and incident cardiovascular events. A metaregression analysis of published data from 20 studies of 95,783 individuals followed for 12.4 years. Diabetes Care 1999; 22(2): 233-240.

Heart Outcome Prevention Evaluation (HOPE) Study Investigators. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO HOPE sub study. Lancet 2000; 255:253-259

Gerstein HC, Mann JF, Yi Q et al. Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. JAMA 2001; 286(4): 421-426

Gerstein HC, Pogue J, Mann JF et al. The relationship between dysglycemia and cardiovascular and renal risk in diabetic and non-diabetic participants in the HOPE study: a prospective epidemiological analysis. Diabetologia 2005; 48(9): 1749-1755

Gerstein HC, Anand S, Yi Q, Vuksan V, Lonn EM, Teo K, Malmberg K, McQueen M, Yusuf S. The relationship between dysglycemia and atherosclerosis in South Asian, Chinese and European individuals in Canada: A randomly sampled cross-sectional study. Diabetes Care 2003; 26: 144-149.

DREAM Trial Investigators. Effect of ramipril on the incidence of diabetes. N.Engl.J Med. 2006; 355: 1551-1562.

DREAM Trial Investigators. Effect of rosiglitazone on the frequency of diabetes in patients with impaired glucose tolerance or impaired fasting glucose: a randomised controlled trial. Lancet 2006; 368: 1096-1105.

 ACCORD Study Group. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008; 358(24):2545-59.
 Gerstein HC. Is it possible to reduce cardiovascular risk with glucose-lowering approaches? Nat Rev Endocrinol.2009;5(5):270-5.


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Population Health Research Institute • Hamilton, Ontario • information@phri.ca