血糖化ヘモグロビンの測定と心血管疾患の予測

, Emanuele Di Angelantonio¹, Pei Gao¹

¹University of Cambridge, Cambridge, United Kingdom.

JAMA

|March 27, 2014

まとめ

糖分化ヘモグロビン (HbA1c) の測定は,糖尿病のない個人の心血管疾患 (CVD) リスクを予測する上で最小限の追加の利益を提供します. この発見は,現在のリスク要因がCVDイベントの予測に大きく十分であることを示唆しています.

科学分野:

心臓病学心臓病学
エンドクリノロジーエンドクリノロジー
予防医学は,予防的な医療です.

背景:

初期心血管疾患に対するグリケイドヘモグロビン (HbA1c) の予測値は十分に確立されていません.
従来の心血管疾患のリスク要因は,個人の心血管疾患 (CVD) のリスクを推定するために使用されます.

研究の目的:

HbA1c測定を既存の心血管リスク評価モデルに組み込むことで,CVDリスクの予測が改善されるかどうかを評価する.
心血管イベントの予測のためのHbA1cテストのインクリメンタル・ベネフィットを決定する.

主な方法:

73の前向きな研究から得られた個々の参加者のデータを分析し,糖尿病やCVDの症状のない294,998人の参加者を対象とした.
評価されたリスク差別はC指数を用いて,再分類は10年CVDリスクカテゴリーの純再分類改善を用いて行われます.

主要な成果:

HbA1cレベルとCVDリスクの間の約J形の関連が観察され,脂質または腎臓機能に調整した後にわずかな変化がありました.
従来の危険因子にHbA1cを加えた結果,C指数 (0.0018) がわずかに上昇し,再分類の純改善 (0.42) がもたらされた.
HbA1cは,空腹,ランダム,またはポストロードのグルコース測定と比較して,同様のまたはより良い予測的改善をもたらしました.

結論:

診断されたCVDや糖尿病のない個体では,HbA1cの測定は将来の心血管疾患の予測にほとんど追加価値を提供しません.
従来的な要因を組み込んだ現在の心血管リスク評価モデルは,リスクの層分化に大きく適しているように見える.

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