Glycated Hemoglobin and Subclinical Atherosclerosis in People Without Diabetes
Glycated Hemoglobin and Subclinical Atherosclerosis in People Without Diabetes
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DOI：
10.1016/j.jacc.2021.03.335
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发表时间：
2021-05-31
影响因子：
24
通讯作者：
Fuster, Valentin
中科院分区：
文献类型：
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作者：
Rossello, Xavier;Raposeiras-Roubin, Sergio;Fuster, Valentin
以糖化血红蛋白（HbA1c）水平监测的蛋白糖化引起的代谢损伤在大多数风险评分（即系统冠状动脉风险评估或动脉粥样硬化性心血管疾病风险量表）中没有体现。本研究的目的是评估HbA1c与亚临床动脉粥样硬化（SA）程度之间的关系，并在关键心血管危险因素（cvrf）的基础上，利用HbA1c更好地识别广泛性SA高风险个体。方法：对来自PESA（早期亚临床动脉粥样硬化进展）研究的3,973名无心血管病史且HbA1c在非糖尿病范围内的中年人进行队列研究，通过二维血管超声和非对比心脏计算机断层扫描评估SA的存在和程度。在调整已建立的cvrf后，HbA1c显示与SA的多区域范围相关（优势比分别为1.05、1.27、1.27、1.36、1.80、1.87和2.47，HbA1c分别为4.9%至5.0%、5.1%至5.2%、5.3%至5.4%、5.5%至5.6%、5.7%至5.8%、5.9%至6.0%和6.1%至6.4%；参考HbA1c #为4.8%,p < 0.001）。这种关联在所有糖尿病前期组中都是显著的，甚至低于糖尿病前期的临界值（HbA1c 5.5%至5.6%的优势比：1.36[95%置信区间：1.03至1.80];p = 0.033）。在低危人群中，高HbA1c与SA风险增加相关（p < 0.001），但在中等危人群中无相关（p = 0.335）。使用系统冠状动脉风险评估或动脉粥样硬化性心血管疾病预测因子进行的相对风险评估证实，在大多数风险类别中，纳入HbA1c可改变多区域SA的风险。结论：常规使用HbA1c可以识别出在传统cvrf基础上SA风险较高的无症状个体。生活方式干预和新型抗糖尿病药物可能被认为可以降低非糖尿病患者的HbA1c水平和SA。[J]中华医学会心内科杂志2021；77:2777-91。由爱思唯尔代表美国心脏病学会基金会出版。这是一篇基于CC BY-NC-ND许可（http://creativecommons.org/licenses/by-nc-nd/4.0/）的开放获取文章。
BACKGROUND The metabolic injury caused by protein glycation, monitored as the level of glycated hemoglobin (HbA1c), is not represented in most risk scores (i.e., Systematic Coronary Risk Estimation or atherosclerotic cardiovascular disease risk scale). OBJECTIVES The purpose of this study was to assess the association between HbA1c and the extent of subclinical atherosclerosis (SA) and to better identify individuals at higher risk of extensive SA using HbA1c on top of key cardiovascular risk factors (CVRFs). METHODS A cohort of 3,973 middle-aged individuals from the PESA (Progression of Early Subclinical Atherosclerosis) study, with no history of cardiovascular disease and with HbA1c in the nondiabetic range, were assessed for the presence and extent of SA by 2-dimensional vascular ultrasound and noncontrast cardiac computed tomography. RESULTS After adjusting for established CVRFs, HbA1c showed an association with the multiterritorial extent of SA (odds ratio: 1.05, 1.27, 1.27, 1.36, 1.80, 1.87, and 2.47 for HbA1c 4.9% to 5.0%, 5.1% to 5.2%, 5.3% to 5.4%, 5.5% to 5.6%, 5.7% to 5.8%, 5.9% to 6.0%, and 6.1% to 6.4%, respectively; reference HbA1c #4.8%; p < 0.001). The association was significant in all pre-diabetes groups and even below the pre-diabetes cut-off (HbA1c 5.5% to 5.6% odds ratio: 1.36 [95% confidence interval: 1.03 to 1.80]; p = 0.033). High HbA1c was associated with an increased risk of SA in low-risk individuals (p < 0.001), but not in moderate-risk individuals (p = 0.335). Relative risk estimations using Systematic Coronary Risk Estimation or atherosclerotic cardiovascular disease predictors confirmed that inclusion of HbA1c modified the risk of multiterritorial SA in most risk categories. CONCLUSIONS Routine use of HbA1c can identify asymptomatic individuals at higher risk of SA on top of traditional CVRFs. Lifestyle interventions and novel antidiabetic medications might be considered to reduce both HbA1c levels and SA in individuals without diabetes. (J Am Coll Cardiol 2021;77:2777-91) (c) 2021 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).