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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.
Cardiovasc. Diabetol. 20:223 (2021)
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.
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Publication type
Article: Journal article
Document type
Scientific Article
Keywords
Biomarcare (biomarker For Cardiovascular Risk Assessment In Europe) ; Biomarkers ; Cardiovascular Risk ; Glycated Hemoglobin A (hba ) 1c 1c ; Morgam (monica Risk Genetics Archiving And Monograph) ; Mortality; Atherosclerosis Risk; Glycemic Control; Artery-disease; Mortality; Glucose; A1c; Prediction; Participants; Hba(1c); People
Language
english
Publication Year
2021
HGF-reported in Year
2021
ISSN (print) / ISBN
1475-2840
e-ISSN
1475-2840
Journal
Cardiovascular Diabetology
Quellenangaben
Volume: 20,
Issue: 1,
Article Number: 223
Publisher
Bmc
Publishing Place
Campus, 4 Crinan St, London N1 9xw, England
Reviewing status
Peer reviewed
Institute(s)
Institute of Epidemiology (EPI)
POF-Topic(s)
30202 - Environmental Health
Research field(s)
Genetics and Epidemiology
PSP Element(s)
G-504000-002
G-504000-010
G-504090-001
G-504000-010
G-504090-001
Grants
Medical Research Council, London
EU
EU
WOS ID
WOS:000718820800001
Scopus ID
85119064100
PubMed ID
34781939
Erfassungsdatum
2021-11-29