 |
|
Hemoglobin A1c Level and Future Cardiovascular Events Among Women
Gavin J. Blake, MD, MPH, MSc, MRCPI;
Aruna D. Pradhan, MD, MPH;
JoAnn E. Manson, MD, DrPH;
G. Rhys Williams, ScD;
Julie Buring, ScD;
Paul M. Ridker, MD, MPH;
Robert J. Glynn, ScD
Arch Intern Med. 2004;164:757-761.
Background Available data suggest that hemoglobin A1c (A1c), also known as glycosylated hemoglobin, levels may be related to cardiovascular risk in the general population without diabetes mellitus. We sought to test this hypothesis prospectively in a cohort of women without overt cardiovascular disease.
Methods We conducted a nested case-control study of the Women's Health Study cohort. We identified 464 case patients with incident myocardial infarction, stroke, or coronary revascularization and 928 unmatched control subjects who remained free of cardiovascular events at case diagnosis. The mean follow-up was 7 years.
Results Of the overall study population, 136 had a history of diabetes mellitus or an overtly elevated baseline A1c level (>6.4%) and were excluded from the primary analyses. Among women without diabetes mellitus or an elevated baseline A1c level, mean ± SD baseline levels of A1c were significantly higher among future cases than controls (5.47% ± 0.27% vs 5.37% ± 0.22%; P<.001). The crude relative risks (RRs) of incident cardiovascular events for increasing quartiles of A1c were 1.00, 0.98, 1.33, and 2.25 (95% confidence interval [CI] for the highest vs the lowest quartile, 1.59-3.18). The A1c levels correlated with several other traditional cardiovascular risk factors, and in fully adjusted models, the predictive effect of A1c was attenuated and not significant (RR for the highest vs the lowest quartile, 1.00; 95% CI, 0.65-1.54). In contrast, in the population including women with diabetes mellitus at enrollment, diabetes mellitus (RR, 4.97; 95% CI, 2.81-8.77) remained a strong independent determinant of cardiovascular risk in fully adjusted analyses, while A1c levels did not (RR for the highest vs the lowest quartile, 1.11; 95% CI, 0.73-1.71).
Conclusions The A1c level is associated with future cardiovascular risk among women without diabetes mellitus, but this relationship is largely attributable to a strong correlation with other cardiovascular risk factors. In contrast, diabetes mellitus is a strong independent determinant of cardiovascular risk, even after adjustment for A1c levels.
From the Cardiovascular Division (Drs Blake, Pradhan, and Ridker), the Center for Cardiovascular Disease Prevention (Drs Blake, Pradhan, and Ridker), and the Division of Preventive Medicine (Drs Blake, Pradhan, Manson, Buring, Ridker, and Glynn), Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; and Bristol-Myers Squibb, Princeton, NJ (Dr Williams). Dr Blake is now with the Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland. The authors have no relevant financial interest in this article.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Association Between Maintenance of Certification Examination Scores and Quality of Care for Medicare Beneficiaries
Holmboe et al.
Arch Intern Med 2008;168:1396-1403.
ABSTRACT
| FULL TEXT
A New Zealand Linkage Study Examining the Associations Between A1C Concentration and Mortality
Brewer et al.
Diabetes Care 2008;31:1144-1149.
ABSTRACT
| FULL TEXT
A1C and Survival in Maintenance Hemodialysis Patients
Kalantar-Zadeh et al.
Diabetes Care 2007;30:1049-1055.
ABSTRACT
| FULL TEXT
Socially Isolated Children 20 Years Later: Risk of Cardiovascular Disease
Caspi et al.
Arch Pediatr Adolesc Med 2006;160:805-811.
ABSTRACT
| FULL TEXT
A Prospective Study of Hemoglobin A1c Concentrations and Risk of Breast Cancer in Women.
Lin et al.
Cancer Res. 2006;66:2869-2875.
ABSTRACT
| FULL TEXT
Hemoglobin A1c Concentrations and Risk of Colorectal Cancer in Women
Lin et al.
Cancer Epidemiol. Biomarkers Prev. 2005;14:3010-3012.
FULL TEXT
Glycosylated Hemoglobin and Mortality in Patients with Nondiabetic Chronic Kidney Disease
Menon et al.
J. Am. Soc. Nephrol. 2005;16:3411-3417.
ABSTRACT
| FULL TEXT
Glycemic Control and Coronary Heart Disease Risk in Persons With and Without Diabetes: The Atherosclerosis Risk in Communities Study
Selvin et al.
Arch Intern Med 2005;165:1910-1916.
ABSTRACT
| FULL TEXT
Glycemic Control, Atherosclerosis, and Risk Factors for Cardiovascular Disease in Individuals With Diabetes: The Atherosclerosis Risk in Communities study
Selvin et al.
Diabetes Care 2005;28:1965-1973.
ABSTRACT
| FULL TEXT
Relationship Between HbA1c Level and Peripheral Arterial Disease
Muntner et al.
Diabetes Care 2005;28:1981-1987.
ABSTRACT
| FULL TEXT
|
