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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Published:2021-11-15
Issue:1
Volume:20
Page:
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ISSN:1475-2840
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Container-title:Cardiovascular Diabetology
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language:en
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Short-container-title:Cardiovasc Diabetol
Author:
Sinning ChristophORCID, Makarova Nataliya, Völzke Henry, Schnabel Renate B., Ojeda Francisco, Dörr Marcus, Felix Stephan B., Koenig Wolfgang, Peters Annette, Rathmann Wolfgang, Schöttker Ben, Brenner Hermann, Veronesi Giovanni, Cesana Giancarlo, Brambilla Paolo, Palosaari Tarja, Kuulasmaa Kari, Njølstad Inger, Mathiesen Ellisiv Bøgeberg, Wilsgaard Tom, Blankenberg Stefan, Söderberg Stefan, Ferrario Marco M., Thorand BarbaraORCID
Abstract
Abstract
Background
Biomarkers may contribute to improved cardiovascular risk estimation. Glycated hemoglobin A1c (HbA1c) is used to monitor the quality of diabetes treatment. Its strength of association with cardiovascular outcomes in the general population remains uncertain. This study aims to assess the association of HbA1c with cardiovascular outcomes in the general population.
Methods
Data 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) incidence, and overall mortality in subjects without diabetes (N = 32,496) and with diabetes (N = 3684).
Results
Kaplan–Meier curves showed higher event rates with increasing HbA1c levels (log-rank-test: p < 0.001). Cox regression analysis revealed significant associations between HbA1c (in mmol/mol) in the total study population and the examined outcomes. Thus, a hazard ratio (HR) of 1.16 (95% confidence interval (CI) 1.02–1.31, p = 0.02) for cardiovascular mortality, 1.13 (95% CI 1.03–1.24, p = 0.01) for CVD incidence, and 1.09 (95% CI 1.02–1.17, p = 0.01) for overall mortality was observed per 10 mmol/mol increase in HbA1c. The association with CVD incidence and overall mortality was also observed in study participants without diabetes with increased HbA1c levels (HR 1.12; 95% CI 1.01–1.25, p = 0.04) and HR 1.10; 95% CI 1.01–1.20, p = 0.02) respectively. 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 incidence, and overall mortality, showed also an increased risk.
Conclusions
HbA1c is independently associated with cardiovascular mortality, overall mortality and cardiovascular disease in the general European population. A mostly monotonically increasing relationship was observed between HbA1c levels and outcomes. Elevated HbA1c levels were associated with cardiovascular disease incidence and overall mortality in participants without diabetes underlining the importance of HbA1c levels in the overall population.
Funder
eu projects morgam genomeutwin engage chances biomarcare eucanshare affect-eu medical research council, london
Publisher
Springer Science and Business Media LLC
Subject
Cardiology and Cardiovascular Medicine,Endocrinology, Diabetes and Metabolism
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