Steven A. Smith, MD
Are glycated hemoglobin (HbA1c) and fasting glucose levels in adults associated with risk for diabetes, coronary heart disease, ischemic stroke, or death?
Cohort study (Atherosclerosis Risk in Communities [ARIC] study) with follow-up visits at 3 and 6 years and then annual telephone follow-up to a median of about 14 years.
4 communities in the USA.
11 092 black or white adults (mean age 57 y, 58% women) who attended study visit 2 (enrollment for current cohort). Exclusion criteria included history of diabetes (self-reported or use of diabetes medication) or cardiovascular disease, validated cardiovascular event between study visits 1 and 2, or nonfasting at visit 2.
HbA1c and fasting glucose levels. Analyses were adjusted for age, sex, race, lipid levels (high- and low-density lipoprotein cholesterol and triglycerides), body mass index, waist-to-hip ratio, hypertension, family history of diabetes, education level, alcohol use, smoking status, and physical activity level.
Diabetes, based on self-report or use of diabetes medication, mortality, coronary heart disease, and ischemic stroke.
Multivariate analyses showed that higher levels of baseline HbA1c were associated with increased risk for diabetes (Table), coronary heart disease (hazard ratio [HR] for each 1% absolute increase 1.19, 95% CI 1.11 to 1.27), and ischemic stroke (HR 1.34, 95% CI 1.22 to 1.48) over 15 years. HbA1c levels < 5% and ≥ 5.5% were associated with increased risk for mortality (Table). Results were similar after adjusting for baseline fasting glucose levels.
In middle-aged adults, higher “normal” levels of glycated hemoglobin were associated with increased risk for diabetes, coronary heart disease, ischemic stroke, and total mortality.
Risk for diabetes and all-cause mortality by HbA1c levels in middle-aged adults*
*HbA1c = glycated hemoglobin; HR = hazard ratio.
†Adjusted for age, sex, race (black or white), low- and high-density lipoprotein cholesterol levels, triglyceride levels, body mass index, waist-to-hip ratio, hypertension, family history of diabetes, education level, alcohol use, smoking status, and physical activity level.
‡Significant trend (P < 0.001) across HbA1c levels.
§Hazard ratio for each 1% absolute increase in HbA1c level.
||Based on data provided by author.
Smith SA. Higher “normal” glycated hemoglobin levels were associated with increased risk for diabetes, CVD, stroke, and mortality in adults. Ann Intern Med. 2010;153:JC1–13. doi: 10.7326/0003-4819-153-2-201007200-02013
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Published: Ann Intern Med. 2010;153(2):JC1-13.
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism, Neurology.
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