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Glycated hemoglobin, diabetes, and cardiovascular risk in nondiabetic adults

Elizabeth Selvin1, Michael W Steffes, Hong Zhu

  • 1Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21287, USA. lselvin@jhsph.edu

The New England Journal of Medicine
|March 5, 2010
PubMed

Insights

Glycated hemoglobin (HbA1c) is a valuable tool for diagnosing diabetes and predicting cardiovascular disease risk. This study found HbA1c better predicts cardiovascular outcomes and death than fasting glucose in adults.

Area of Science:

  • Endocrinology and Metabolism
  • Cardiovascular Disease Epidemiology
  • Diagnostic Biomarkers

Background:

  • Fasting glucose is the standard diagnostic criterion for diabetes in the US.
  • Glycated hemoglobin (HbA1c) has recently been recommended as an alternative diagnostic measure.
  • The comparative prognostic value of HbA1c versus fasting glucose for diabetes and cardiovascular disease (CVD) risk requires further investigation.

Purpose of the Study:

  • To compare the prognostic capabilities of glycated hemoglobin (HbA1c) and fasting glucose.
  • To assess the risk prediction for incident diabetes and cardiovascular disease (CVD).
  • To evaluate the association with all-cause mortality in a diverse adult population.

Main Methods:

  • Prospective cohort study involving 11,092 non-diabetic black and white adults from the Atherosclerosis Risk in Communities (ARIC) study.
  • Baseline measurement of glycated hemoglobin (HbA1c) and fasting glucose.
  • Analysis of incident diabetes diagnoses, cardiovascular events (coronary heart disease, stroke), and all-cause mortality.

Main Results:

  • Glycated hemoglobin (HbA1c) demonstrated a strong, dose-dependent association with incident diabetes and cardiovascular outcomes, including coronary heart disease and stroke.
  • HbA1c was also significantly associated with all-cause mortality, exhibiting a J-shaped curve.
  • These associations remained significant after adjusting for fasting glucose, whereas the association of fasting glucose with CVD risk and mortality was not significant when HbA1c was included in the models.

Conclusions:

  • In non-diabetic adults, glycated hemoglobin (HbA1c) is similarly associated with diabetes risk and more strongly associated with cardiovascular disease and all-cause mortality risk compared to fasting glucose.
  • The addition of HbA1c to risk prediction models significantly improved discrimination for coronary heart disease.
  • These findings support the utility of HbA1c as a diagnostic and prognostic tool for diabetes and cardiovascular risk assessment.
Abstract

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