(11-05-11) Glycated Hemoglobin Predicts All-Cause, Cardiovascular, and Cancer Mortality in People Without a History of Diabetes Undergoing Cor

Glycated Hemoglobin Predicts All-Cause, Cardiovascular, and Cancer Mortality in People Without a History of Diabetes Undergoing Coronary Angiography.


Silbernagel G, Grammer TB, Winkelmann BR, Boehm BO, M?rz W.
Source
Department of Internal Medicine, Division of Endocrinology, Diabetology,
Nephrology, Vascular Disease, and Clinical Chemistry, Eberhard-Karls-University
T?bingen, T?bingen, Germany.
Abstract
OBJECTIVE Glycated hemoglobin has been suggested to be superior to fasting
glucose for the prediction of vascular disease and death from any cause. The
aim of the present work was to analyze and compare the predictive value of
glycated hemoglobin and fasting glucose on all-cause and cause-specific
mortality in subjects who underwent coronary angiography. RESEARCH DESIGN AND
METHODS We studied 2,686 participants of the Ludwigshafen Risk and
Cardiovascular health study without a history of diabetes. The majority of this
cohort had coronary artery disease. Glycated hemoglobin was measured at the
baseline examination. The mean (? SD) duration of the follow-up for all-cause,
cardiovascular, and cancer mortality was 7.54 ? 2.1 years. RESULTS A total of
508 deaths occurred during the follow-up. Of those, 299 were accounted for by
cardiovascular diseases and 79 by cancer. Baseline glycated hemoglobin was
predictive of all-cause, cardiovascular, and cancer mortality. The
multivariable-adjusted hazard ratios (HR) (95% CI) for glycated hemoglobin
values of <5.0, 5.0-5.4, 5.5-5.9, 6.0-6.4, 6.5-7.4, and ≥7.5% for all-cause
mortality were 1.36 (0.85-2.18), 1.00 (0.76-1.32), 1.00 (reference), 1.11 (0.88-
1.41), 1.39 (1.07-1.82), and 2.15 (1.32-3.53), respectively. Similar J-shaped
relationships were found between glycated hemoglobin and cardiovascular and
cancer mortality. The associations of glycated hemoglobin with all-cause and
cardiovascular mortality remained significant after inclusion of fasting
glucose as a covariate. However, fasting glucose was not significantly related
to mortality when adjusting for glycated hemoglobin. CONCLUSIONS Glycated
hemoglobin significantly and independently of fasting glucose predicts all-
cause and cardiovascular mortality in whites at intermediate to high
cardiovascular risk.

Source: Diabetes Care. 2011 Apr 22. [Epub ahead of print]

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