What Is Behind the HbA1c Value?
What Is Behind the HbA1c Value?
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HbA1c 值的背后是什么？
DOI：
10.1016/j.jacc.2021.06.054
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发表时间：
2021
影响因子：
24
通讯作者：
Koichi Node
中科院分区：
文献类型：
--
作者：
Atsushi Tanaka;Koichi Node
在最近一期杂志中，罗塞洛等人（1）使用PESA（早期亚临床动脉粥样硬化进展）研究的数据表明，在无糖尿病的受试者中，前驱糖尿病和甚至更低范围的糖化血红蛋白（HbA 1c）与亚临床动脉粥样硬化（SA）的患病率和程度密切相关。在日常临床实践中，HbA 1c水平的测量并不总是在无糖尿病的受试者中进行，而低于糖尿病范围的水平也通常不进行治疗。罗塞洛等人（1）的研究结果揭示了常规测量非糖尿病受试者HbA 1c水平的临床意义，不仅可以预防糖尿病的发生，还可以估计SA和后续心血管疾病（CVD）的风险，并监测治疗干预对该风险的影响。因此，预计HbA 1c水平将成为超越糖尿病护理临床环境的多能和强大的心脏代谢标志物。然而，由于本研究的横截面设计，一些问题仍有待澄清。首先，从单次测量获得的HbA 1c值并不反映先前的水平，并且先前的HbA 1c水平可能是动脉壁上的持续负担。虽然HbA 1c波动小于血糖，但其水平的潜在变异性可能会影响SA的发展和CVD的风险，如2型糖尿病患者所见（2）。其次，HbA 1c水平在非糖尿病范围内与SA相关的潜在机制仍不确定。在非糖尿病受试者中检测到的SA对CVD发病率和死亡率的纵向影响也未知。除蛋白质糖化外，其他混杂因素如高血压和血脂异常也共同促进代谢和心血管负担。因此，需要进一步研究：1）评估如何安全有效地管理非糖尿病范围的HbA 1c; 2）确定进一步降低HbA 1c水平对SA的治疗影响。因此，低于目前推荐的HbA 1c目标的个性化HbA 1c目标可能有助于减少动脉粥样硬化进展，即使是糖尿病患者。
In a recent issue of the Journal, Rossello et al (1) used data from the PESA (Progression of Early Subclinical Atherosclerosis) study to show that prediabetes and even lower ranges of glycated hemoglobin (HbA1c) were associated closely with the prevalence and extent of subclinical atherosclerosis (SA) in subjects without diabetes. Measurement of HbA1c levels is not always performed in subjects without diabetes in daily clinical practice, whereas levels below the diabetic range are also often left untreated. The findings of Rossello et al (1) shed new light on the clinical significance of routinely measuring HbA1c levels in subjects without diabetes not only to prevent development of diabetes, but also to estimate the risk of SA and subsequent cardiovascular disease (CVD) and to monitor the effect of therapeutic interventions on this risk. It is therefore expected that HbA1c level will become a multipotent and powerful cardiometabolic marker beyond the clinical setting of diabetes care. However, because of the cross-sectional design of the present study, some questions remain to be elucidated. First, the HbA1c value obtained from a single measurement does not reflect previous levels, and it is possible that a previous HbA1c level may be a continual burden on the arterial wall. Although HbA1c fluctuates less than blood glucose, potential variability in its level may influence the development of SA and risk of CVD, as seen in patients with type 2 diabetes (2). Second, the underlying mechanisms by which HbA1c levels in the nondiabetic range relate to SA remain uncertain. The longitudinal impact of SA detected in subjects without diabetes on the incidence of CVD and mortality is also unknown. In addition to protein glycation, other confounding factors such as hypertension and dyslipidemia cofacilitate metabolic and cardiovascular burdens. Further study is therefore needed: 1) to assess how to manage nondiabetic range HbA1c safely and effectively; and 2) to determine the therapeutic impact of further reducing HbA1c level on SA. As a consequence, the lower personalized HbA1c targets than those currently recommended may therefore be helpful for reducing atherosclerosis progression even in patients with diabetes.
影响因子：
24
作者：
Rossello, Xavier;Raposeiras-Roubin, Sergio;Fuster, Valentin
通讯作者：
Fuster, Valentin
影响因子：
16.2
作者：
Li, Sheyu;Nemeth, Imola;Pearson, Ewan R.
通讯作者：
Pearson, Ewan R.