OBJECTIVE To examine the change in fasting blood glucose (FBG) during repeated assessments over time and its potential impact on the risk of developing myocardial infarction (MI).

RESEARCH DESIGN AND METHODS This prospective cohort study included 68,297 participants without diabetes (mean age 49 years) who were free of MI, stroke, and cancer prior to or in 2010 (baseline of the current analysis). FBG concentrations were measured in 2006, 2008, and 2010. The FBG trajectories during 2006–2010, the primary exposure of the current study, were identified by latent mixture modeling. Incident MI cases were confirmed via review of medical records by cardiologists.

RESULTS We identified five discrete FBG trajectories according to FBG range and changing pattern over time: elevated-stable (n = 3,877), elevated-decreasing (n = 7,060), moderate-increasing (n = 10,298), moderate-stable (n = 40,352), and low-stable (n = 6,710). During 4 years of follow-up, we documented 283 incident MI cases. Relative to the moderate-stable pattern (FBG ranged 4.9 to 5.1 mmol/L), adjusted hazard ratios (HRs) were 1.53 (95% CI 1.04, 2.26) for the elevated-stable pattern (FBG ranged 6.1 to 6.3 mmol/L) and HR 0.61 (95% CI 0.38, 0.98) for the elevated-decreasing pattern (FBG decreased from 6.0 to 5.4 mmol/L), after adjustment for potential confounders such as age, sex, lifestyle factors, obesity, medical history, blood pressure, blood lipids, and C-reactive protein. Consistently, cumulative average and increasing rate of FBG during 2006–2010, but not a single baseline FBG, predicted future risk of MI.

CONCLUSIONS We found that discrete FBG trajectories were significantly associated with subsequent risk of MI in individuals without diabetes. These observations suggest that long-term trajectories of FBG may be important for risk prediction of MI and possibly other macrovascular diseases.

目的研究长期反复评估期间空腹血糖（FBG）的变化及其对发展为心肌梗塞（MI）的风险的潜在影响。

研究设计与方法这项前瞻性队列研究纳入了68,297名无糖尿病（平均年龄49岁）的参与者，这些参与者在2010年之前或2010年没有心梗，中风和癌症（当前分析的基线）。在2006年，2008年和2010年测量了FBG浓度。通过潜在混合物模型确定了2006-2010年FBG轨迹，这是本研究的主要暴露对象。通过心脏病专家对病历的审查，确认了MI事件。

结果我们根据FBG范围和随时间变化的模式确定了五个离散的FBG轨迹：升高稳定（n = 3,877），升高减少（n = 7,060），中等增加（n = 10,298），中等稳定（n = 40,352）和低稳定（n= 6,710）。在4年的随访期间，我们记录了283起MI事件。相对于中稳定模式（FBG范围为4.9至5.1 mmol / L），升高稳定模式（FBG范围为6.1至6.3 mmol / L）的调整后危险比（HRs）为1.53（95％CI 1.04，2.26）调整了年龄，性别，生活方式因素，肥胖，病史，血压等潜在混杂因素后，升高-降低模式（FBG从6.0降至5.4 mmol / L）的HR为0.61（95％CI 0.38，0.98） ，血脂和C反应蛋白。一致地，在2006–2010年期间，FBG的累积平均水平和增长率，但没有单一的基线FBG预测了MI的未来风险。

结论我们发现离散的FBG轨迹与非糖尿病患者随后发生MI的风险显着相关。这些观察结果表明，FBG的长期轨迹对于MI以及其他大血管疾病的风险预测可能很重要。