Association of glycated hemoglobin A1c levels with cardiovascular outcomes in the general population: Results from the BiomarCaRE (Biomarker for Cardiovascular Risk Assessment in Europe) consortium
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Association of glycated hemoglobin A1c levels with cardiovascular outcomes in the general population: Results from the BiomarCaRE (Biomarker for Cardiovascular Risk Assessment in Europe) consortium
BackgroundBiomarkers may contribute to improved cardiovascular risk estimation. Glycated hemoglobin A1c (HbA1c) is used to monitor the quality of diabetes treatment. Its role for prediction of cardiovascular outcomes in the general population remains uncertain. This study aims to assess the role of HbA1c in predicting cardiovascular outcomes in the general population.MethodsData from six prospective population-based cohort studies across Europe comprising 36,180 participants were analyzed. HbA1c was evaluated in conjunction with classical cardiovascular risk factors (CVRFs) for association with cardiovascular mortality, cardiovascular disease (CVD), and overall mortality in subjects without diabetes (N=32,477) and with diabetes (N=3,703). ResultsKaplan-Meier curves showed higher event rates with increasing HbA1c levels (log-rank-test: p1c (in mmol/mol) log-transformed and divided by interquartile range in the total study population and the examined outcomes. Thus, a hazard ratio (HR) of 1.12 (95% confidence interval (CI): 1.04−1.20, p=0.002) for cardiovascular mortality, 1.10 (95% CI: 1.04−1.16, p1c levels (HR 1.09; 95% CI: 1.01-1.16, p=0.021).HbA1c cut-off values of 39.9 mmol/mol (5.8%), 36.6 mmol/mol (5.5%), and 38.8 mmol/mol (5.7%) for cardiovascular mortality, CVD, and overall mortality, respectively, show an increased risk for the outcome.ConclusionsHbA1c was demonstrated to be an independent prognostic biomarker for all investigated outcomes in the general European population. A mostly monotonically increasing relationship was observed between HbA1c levels and outcomes. Elevated HbA1c levels were also associated with the outcomes in participants without diabetes (i.e., HbA1c levels < 6.5% (1c levels in the overall population.
BackgroundBiomarkers may contribute to improved cardiovascular risk estimation. Glycated hemoglobin A1c (HbA1c) is used to monitor the quality of diabetes treatment. Its role for prediction of cardiovascular outcomes in the general population remains uncertain. This study aims to assess the role of HbA1c in predicting cardiovascular outcomes in the general population.MethodsData from six prospective population-based cohort studies across Europe comprising 36,180 participants were analyzed. HbA1c was evaluated in conjunction with classical cardiovascular risk factors (CVRFs) for association with cardiovascular mortality, cardiovascular disease (CVD), and overall mortality in subjects without diabetes (N=32,477) and with diabetes (N=3,703). ResultsKaplan-Meier curves showed higher event rates with increasing HbA1c levels (log-rank-test: p1c (in mmol/mol) log-transformed and divided by interquartile range in the total study population and the examined outcomes. Thus, a hazard ratio (HR) of 1.12 (95% confidence interval (CI): 1.04−1.20, p=0.002) for cardiovascular mortality, 1.10 (95% CI: 1.04−1.16, p1c levels (HR 1.09; 95% CI: 1.01-1.16, p=0.021).HbA1c cut-off values of 39.9 mmol/mol (5.8%), 36.6 mmol/mol (5.5%), and 38.8 mmol/mol (5.7%) for cardiovascular mortality, CVD, and overall mortality, respectively, show an increased risk for the outcome.ConclusionsHbA1c was demonstrated to be an independent prognostic biomarker for all investigated outcomes in the general European population. A mostly monotonically increasing relationship was observed between HbA1c levels and outcomes. Elevated HbA1c levels were also associated with the outcomes in participants without diabetes (i.e., HbA1c levels < 6.5% (1c levels in the overall population.
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