High blood glucose concentrations cause millions of cardiovascular deaths worldwide

There's a fairly straightforward, direct, and continuous association between plasma concentrations of glucose and risk of heart disease and stroke, and it starts well below the conventional thresholds used to define diabetes. So it's important to look beyond frank diabetes for a clearer picture of the global impact of impaired glucose tolerance on public health. The latest estimates, derived from population surveys and meta-analyses of published data, show that worldwide at least three million people a year die from cardiovascular disease because their blood glucose concentrations are less than ideal. About one million of them have diabetes. “Higher than optimum” blood glucose concentrations are responsible for the remaining one and a half million deaths from heart disease and about 700 000 deaths from stroke. So one fifth of all deaths from heart disease worldwide and 13% of all deaths from stroke are attributable to high blood glucose. The bulk of these deaths occur in low and middle income countries, which are least able to tackle the problem. In 2001, an estimated 548 000 people in South Asia alone died of heart disease caused by high blood glucose concentrations—37% of the global total.

If these estimates are accurate, high blood glucose concentrations, not including diabetes, are responsible for a greater proportion of cardiovascular deaths than smoking.