@article{Di Angelantonio2014, abstract = {IMPORTANCE The value of measuring levels of glycated hemoglobin (HbA(1c)) for the prediction of first cardiovascular events is uncertain. OBJECTIVE To determine whether adding information on HbA(1c) values to conventional cardiovascular risk factors is associated with improvement in prediction of cardiovascular disease (CVD) risk. DESIGN, SETTING, AND PARTICIPANTS Analysis of individual-participant data available from 73 prospective studies involving 294 998 participants without a known history of diabetes mellitus or CVD at the baseline assessment. MAIN OUTCOMES AND MEASURES Measures of risk discrimination for CVD outcomes (eg, C-index) and reclassification (eg, net reclassification improvement) of participants across predicted 10-year risk categories of low (= 7.5%) risk. RESULTS During a median follow-up of 9.9 (interquartile range, 7.6-13.2) years, 20 840 incident fatal and nonfatal CVD outcomes (13 237 coronary heart disease and 7603 stroke outcomes) were recorded. In analyses adjusted for several conventional cardiovascular risk factors, there was an approximately J-shaped association between HbA(1c) values and CVD risk. The association between HbA(1c) values and CVD risk changed only slightly after adjustment for total cholesterol and triglyceride concentrations or estimated glomerular filtration rate, but this association attenuated somewhat after adjustment for concentrations of high-density lipoprotein cholesterol and C-reactive protein. The C-index for a CVD risk prediction model containing conventional cardiovascular risk factors alone was 0.7434 (95% CI, 0.7350 to 0.7517). The addition of information on HbA(1c) was associated with a C-index change of 0.0018 (0.0003 to 0.0033) and a net reclassification improvement of 0.42 (-0.63 to 1.48) for the categories of predicted 10-year CVD risk. The improvement provided by HbA(1c) assessment in prediction of CVD risk was equal to or better than estimated improvements for measurement of fasting, random, or postload plasma glucose levels. CONCLUSIONS AND RELEVANCE In a study of individuals without known CVD or diabetes, additional assessment of HbA(1c) values in the context of CVD risk assessment provided little incremental benefit for prediction of CVD risk.}, author = {Di Angelantonio, Emanuele and Angelantonio, Emanuele Di and de-La-Cámara, Agustín Gómez and Gao, Pei and Khan, Hassan and Butterworth, Adam S. and As, Butterworth and Wormser, David and Kaptoge, Stephen and Seshasai, Sreenivasa Rao Kondapally and Sr, Kondapally Seshasai and Kondapally Seshasai, Sreenivasa Rao and Thompson, Alex and Sarwar, Nadeem and Willeit, Peter and Ridker, Paul M. and Pm, Ridker and Barr, Elizabeth L. M. and El, Barr and Khaw, Kay-Tee and Kt, Khaw and Psaty, Bruce M. and Bm, Psaty and Brenner, Hermann and Balkau, Beverley and Dekker, Jacqueline M. and Jm, Dekker and Lawlor, Debbie A. and Da, Lawlor and Daimon, Makoto and Willeit, Johann and Njolstad, Inger and Nissinen, Aulikki and Ej, Brunner and Brunner, Eric J. and Lh, Kuller and Kuller, Lewis H. and Price, Jackie F. and Jf, Price and Sundstrom, Johan and Knuiman, Matthew W. and Mw, Knuiman and Feskens, Edith J. M. and Ej, Feskens and Verschuren, W. M. M. and Wm, Verschuren and Wald, Nicholas and Bakker, Stephan J. L. and Whincup, Peter H. and Sj, Bakker and Ford, Ian and Ph, Whincup and Goldbourt, Uri and Gomez-De-La-Camara, Agustin and Gómez-De-La-Cámara, Agustín and Gallacher, John and Simons, Leon A. and La, Simons and Rosengren, Annika and Sutherland, Susan E. and Se, Sutherland and Bjorkelund, Cecilia and Dg, Blazer and Blazer, Dan G. and Wassertheil-Smoller, Sylvia and Ibanez, Alejandro Marin and Onat, Altan and Marín Ibañez, Alejandro and Wouter Jukema, J. and Casiglia, Edoardo and Jw, Jukema and Jukema, J. Wouter and Lm, Simpson and Simpson, Lara M. and Giampaoli, Simona and Nordestgaard, Borge G. and Bg, Nordestgaard and Selmer, Randi and Wennberg, Patrik and Jt, Salonen and Kauhanen, Jussi and D'Agostino, Ralph B. and Salonen, Jukka T. and Dankner, Rachel and Rb, Wallace and Barrett-Connor, Elizabeth and Kavousi, Maryam and Rb, D'Agostino and Gudnason, Vilmundur and Jg, Umans and Evans, Denis and Wallace, Robert B. and Rf, Gillum and Cushman, Mary and D’Agostino, Ralph B. and Ar, Folsom and Umans, Jason G. and Kiyohara, Yutaka and Yt, van der Schouw and Nakagawa, Hidaeki and Kg, Moons and Sato, Shinichi and Gillum, Richard F. and Sj, Griffin and Folsom, Aaron R. and van der Schouw, Yvonne T. and Nj, Wareham and Moons, Karel G. and Ademoglu, Evin and Griffin, Simon J. and Sattar, Naveed and Sg, Thompson and Wareham, Nicholas J. and Selvin, Elizabeth and Factors, Emerging Risk and Thompson, Simon G. and Collaboration, Emerging Risk Factors and Danesh, John and Harshfield, Eric}, doi = {10.1001/jama.2014.1873}, month = {mar}, title = {Glycated Hemoglobin Measurement and Prediction of Cardiovascular Disease}, url = {http://jama.jamanetwork.com/data/journals/jama/929879/joi140019.pdf}, year = {2014} }