Hemoglobin a1c predicts diabetes but not cardiovascular disease in nondiabetic women
Hemoglobin a1c predicts diabetes but not cardiovascular disease in nondiabetic women
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DOI：
10.1016/j.amjmed.2007.03.022
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发表时间：
2007-08-01
影响因子：
5.9
通讯作者：
Ridker, Paul M.
中科院分区：
文献类型：
--
作者：
Pradhan, Aruna D.;Rifai, Nader;Ridker, Paul M.
背景：血红蛋白A1 c（HbA 1c）是过去2- 3个月内累积血糖暴露的标志物。该生物标志物的轻度升高是否为处于这些疾病的通常风险的个体中临床上明显的2型糖尿病和心血管疾病的发展提供预后信息尚不确定。我们研究了基线HbA 1c水平作为临床糖尿病和心血管疾病事件的预测因子（非致命性心肌梗死，冠状动脉血运重建术，缺血性中风，1992年开始的一项前瞻性队列研究中，26，563名年龄在45岁或以上的美国女性健康专业人员未被诊断为糖尿病或血管疾病结果：随访期间，1238例糖尿病患者和684例心血管事件发生。在使用HbA 1c五分位数的年龄调整分析中，观察到糖尿病和心血管疾病的风险梯度。多变量校正后，HbA 1c仍然是糖尿病的强预测因子，但不再与心血管疾病事件显著相关。在阈值效应分析中，HbA 1c低于5.0%、5.0%至5.4%、5.5%至5.9%、6.0%至6.4%、6.5%至6.9%和7.0%或以上的糖尿病事件的校正相对风险分别为1.0、2.9、12.1、29.3、28.2和81.2。风险协会持续额外调整后C-反应蛋白和排除个人发展中的糖尿病在2年和5年的following.CONCLUSIONS：这些前瞻性研究结果表明，HbA 1c水平升高以及提前临床发展的2型糖尿病，支持最近的建议，降低诊断阈值的葡萄糖代谢紊乱。相比之下，HbA 1c与心血管事件的相关性不大，主要归因于共存的传统风险因素。(c)2007爱思唯尔公司All rights reserved.
BACKGROUND: Hemoglobin A1c (HbA1c) is a marker of cumulative glycemic exposure over the preceding 2- to 3-month period. Whether mild elevations of this biomarker provide prognostic information for development of clinically evident type 2 diabetes and cardiovascular disease among individuals at usual risk for these disorders is uncertain.METHODS: We examined baseline HbA1c levels as a predictor of incident clinical diabetes and cardiovascular disease (nonfatal myocardial infarction, coronary revascularization procedure, ischemic stroke, or death from cardiovascular causes) in a prospective cohort study beginning in 1992 of 26,563 US female health professionals aged 45 years or more without diagnosed diabetes or vascular disease (median follow-up 10.1 years).RESULTS: During follow-up, 1238 cases of diabetes and 684 cardiovascular events occurred. In age-adjusted analyses using quintiles of HbA1c, a risk gradient was observed for both incident diabetes and cardiovascular disease. After multivariable adjustment, HbA1c remained a strong predictor of diabetes but was no longer significantly associated with incident cardiovascular disease. In analyses of threshold effects, adjusted relative risks for incident diabetes in HbA1c categories of less than 5.0%, 5.0% to 5.4%, 5.5% to 5.9%, 6.0% to 6.4%, 6.5% to 6.9%, and 7.0% or more were 1.0, 2.9, 12.1, 29.3, 28.2, and 81.2, respectively. Risk associations persisted after additional adjustment for C-reactive protein and after excluding individuals developing diabetes within 2 and 5 years of follow-up.CONCLUSIONS: These prospective findings suggest that HbA1c levels are elevated well in advance of the clinical development of type 2 diabetes, supporting recent recommendations for lowering of diagnostic thresholds for glucose metabolic disorders. In contrast, the association of HbA1c with incident cardiovascular events is modest and largely attributable to coexistent traditional risk factors. (c) 2007 Elsevier Inc. All rights reserved.