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Association of Hemoglobin A1c with Cardiovascular Disease and Mortality in Adults: The European Prospective Investigation into Cancer in Norfolk

Kay-Tee Khaw, MBBChir FRCP; Nicholas Wareham, MBBS, FRCP; Sheila Bingham, PhD; Robert Luben, BSc; Ailsa Welch, BSc; and Nicholas Day, PhD
[+] Article and Author Information

From University of Cambridge, Medical Research Council Epidemiology Unit, and Medical Research Council Dunn Nutrition Unit, Cambridge, United Kingdom.


Acknowledgments: The authors thank the participants, general practitioners, and staff of EPIC–Norfolk.

Grant Support: EPIC–Norfolk is supported by program grants from the Medical Research Council United Kingdom and Cancer Research United Kingdom. The European Union, Stroke Association, and British Heart Foundation provided additional support.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Kay-Tee Khaw, MBBChir, FRCP, Clinical Gerontology Unit, Box 251, University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge CB2 2QQ, United Kingdom; e-mail, kk101@medschl.cam.ac.uk.

Current Author Addresses: Dr. Khaw: Clinical Gerontology Unit, Box 251, University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge CB2 2QQ, United Kingdom.

Dr. Wareham: Medical Research Council Epidemiology Unit, Strangeways Research Laboratory, Worts Causeway, Cambridge CB1 8RN, United Kingdom.

Dr. Bingham: Medical Research Council Dunn Nutrition Unit, Wellcome Trust/Medical Research Council Building, Hills Road, Cambridge CB2 2XY, United Kingdom.

Mr. Luben, Ms. Welch, and Dr. Day: Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratories, Worts Causeway, Cambridge CB1 8RN, United Kingdom.

Author Contributions: Conception and design: K.-T. Khaw, N. Wareham, S. Bingham, A. Welch, N. Day.

Analysis and interpretation of the data: K.-T. Khaw, N. Wareham.

Drafting of the article: K.-T. Khaw, N. Wareham.

Critical revision of the article for important intellectual content: N. Wareham, S. Bingham, A. Welch, N. Day.

Final approval of the article: K.-T. Khaw, N. Wareham, S. Bingham, R. Luben, A. Welch, N. Day.

Statistical expertise: R. Luben, N. Day.

Obtaining of funding: K.-T. Khaw, N. Wareham, S. Bingham, N. Day.

Administrative, technical, or logistic support: N. Wareham, S. Bingham, R. Luben, A. Welch, N. Day.

Collection and assembly of data: R. Luben, A. Welch.


Ann Intern Med. 2004;141(6):413-420. doi:10.7326/0003-4819-141-6-200409210-00006
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The European Prospective Investigation into Cancer in Norfolk (EPIC–Norfolk) is a prospective population study of 25 623 men and women who were between 40 and 79 years of age and who resided in Norfolk, United Kingdom. Participants were recruited from general practice registers. Information on the recruitment process is available elsewhere (12). Between 1993 and 1997, participants completed a health and lifestyle questionnaire. Participants were asked whether a doctor had ever told them that they have any of the conditions contained in a list that included diabetes, heart attack, and stroke. People with known diabetes were defined as those who responded “yes” to the diabetes option of this question. Smoking history was derived from responses (yes or no) to the questions: “Have you ever smoked as much as 1 cigarette a day for as long as a year?” and “Do you smoke cigarettes now?”

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The A1c recommended level should be lowered
Posted on October 5, 2004
John H. Lange
Envirosafe Training and Consultants
Conflict of Interest: None Declared

Based on the study by Khaw et al (1) there appears to be considerable risk for cardiovascular disease and mortality when the A1c level is 5% or greater. The American Diabetes Association and American Association of Clinical Endocrinologists recommend an A1c goal for diabetics of 7% and 6.5%, respectively (2). Based on Khaw's study, I suggest that this goal for A1c be lowered to a value of 5%.

References

1. Khaw T-T, Wareham N, Bingham S, Luben R, Welch A, Day N. Association of hemoglobin A1c with cardiovascular disease and mortality in adults: the European prospective investigation into cancer in Norfolk. Ann Intern Med 2004;141:413-20.

2. Palumbo PJ. The case for insulin treatment early in type 2 diabetes. Cleveland Clinic Journal of Medicine 2004;71:385-405.

Conflict of Interest:

None declared

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Summary for Patients

The Relationship Between Blood Sugar Levels and Cardiovascular Disease

The summary below is from the full report titled “Association of Hemoglobin A1c with Cardiovascular Disease and Mortality in Adults: The European Prospective Investigation into Cancer in Norfolk.” It is in the 21 September 2004 issue of Annals of Internal Medicine (volume 141, pages 413-420). The authors are K.-T. Khaw, N. Wareham, S. Bingham, R. Luben, A. Welch, and N. Day.

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