Glycated hemoglobin, diabetes, and cardiovascular risk in nondiabetic adults.
Glycated hemoglobin, diabetes, and cardiovascular risk in nondiabetic adults.
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DOI：
10.1056/nejmoa0908359
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发表时间：
2010-03-04
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影响因子：
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通讯作者：
Brancati FL
中科院分区：
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作者：
Selvin E;Steffes MW;Zhu H;Matsushita K;Wagenknecht L;Pankow J;Coresh J;Brancati FL
在美国，空腹血糖是用于诊断糖尿病的标准指标。近期，糖化血红蛋白也被推荐用于此目的。
我们比较了糖化血红蛋白和空腹血糖在识别有患糖尿病或心血管疾病风险的成年人方面的预后价值。我们测量了11092名没有糖尿病或心血管疾病病史且参加了社区动脉粥样硬化风险（ARIC）研究第二次随访（发生在1990 - 1992年期间）的黑人或白人成年人全血样本中的糖化血红蛋白。
基线时的糖化血红蛋白值与新诊断的糖尿病和心血管疾病结局相关。对于糖化血红蛋白值小于5.0%、5.0% - 小于5.5%、5.5% - 小于6.0%、6.0% - 小于6.5%以及6.5%及以上，诊断糖尿病的多变量调整后的风险比（95%置信区间）分别为0.52（0.40 - 0.69）、1.00（参考值）、1.86（1.67 - 2.08）、4.48（3.92 - 5.13）和16.47（14.22 - 19.08）。对于冠心病，风险比分别为0.96（0.74 - 1.24）、1.00（参考值）、1.23（1.07 - 1.41）、1.78（1.48 - 2.15）和1.95（1.53 - 2.48）。中风的风险比与之相似。相比之下，糖化血红蛋白与任何原因导致的死亡呈J形关联曲线。在对基线空腹血糖水平进行调整后，所有这些关联仍然显著。在对所有协变量以及糖化血红蛋白进行调整的模型中，空腹血糖水平与心血管疾病风险或任何原因导致的死亡之间的关联并不显著。对于冠心病，当在包含空腹血糖的模型中加入糖化血红蛋白时，风险判别指标有显著改善。
在这个基于社区的非糖尿病成年人群体中，与空腹血糖相比，糖化血红蛋白与糖尿病风险有相似的关联，且与心血管疾病风险和任何原因导致的死亡风险有更强的关联。这些数据增加了支持将糖化血红蛋白用作糖尿病诊断测试的证据。
Fasting glucose is the standard measure used to diagnose diabetes in the United States. Recently, glycated hemoglobin was also recommended for this purpose. We compared the prognostic value of glycated hemoglobin and fasting glucose for identifying adults at risk for diabetes or cardiovascular disease. We measured glycated hemoglobin in whole-blood samples from 11,092 black or white adults who did not have a history of diabetes or cardiovascular disease and who attended the second visit (occurring in the 1990–1992 period) of the Atherosclerosis Risk in Communities (ARIC) study. The glycated hemoglobin value at baseline was associated with newly diagnosed diabetes and cardiovascular outcomes. For glycated hemoglobin values of less than 5.0%, 5.0 to less than 5.5%, 5.5 to less than 6.0%, 6.0 to less than 6.5%, and 6.5% or greater, the multivariable-adjusted hazard ratios (with 95% confidence intervals) for diagnosed diabetes were 0.52 (0.40 to 0.69), 1.00 (reference), 1.86 (1.67 to 2.08), 4.48 (3.92 to 5.13), and 16.47 (14.22 to 19.08), respectively. For coronary heart disease, the hazard ratios were 0.96 (0.74 to 1.24), 1.00 (reference), 1.23 (1.07 to 1.41), 1.78 (1.48 to 2.15), and 1.95 (1.53 to 2.48), respectively. The hazard ratios for stroke were similar. In contrast, glycated hemoglobin and death from any cause were found to have a J-shaped association curve. All these associations remained significant after adjustment for the baseline fasting glucose level. The association between the fasting glucose levels and the risk of cardiovascular disease or death from any cause was not significant in models with adjustment for all covariates as well as glycated hemoglobin. For coronary heart disease, measures of risk discrimination showed significant improvement when glycated hemoglobin was added to models including fasting glucose. In this community-based population of nondiabetic adults, glycated hemoglobin was similarly associated with a risk of diabetes and more strongly associated with risks of cardiovascular disease and death from any cause as compared with fasting glucose. These data add to the evidence supporting the use of glycated hemoglobin as a diagnostic test for diabetes.