Glycated Hemoglobin Measurement and Prediction of Cardiovascular Disease

All 119 authors (show less):
Emanuele Di Angelantonio, Emanuele Di Angelantonio, Agustín Gómez de-La-Cámara, Pei Gao, Hassan Khan, Adam S. Butterworth, Butterworth As, David Wormser, Stephen Kaptoge, Sreenivasa Rao Kondapally Seshasai, Kondapally Seshasai Sr, Sreenivasa Rao Kondapally Seshasai, Alex Thompson, Nadeem Sarwar, Peter Willeit, Paul M. Ridker, Ridker Pm, Elizabeth L. M. Barr, Barr El, Kay-Tee Khaw, Khaw Kt, Bruce M. Psaty, Psaty Bm, Hermann Brenner, Beverley Balkau, Jacqueline M. Dekker, Dekker Jm, Debbie A. Lawlor, Lawlor Da, Makoto Daimon, Johann Willeit, Inger Njolstad, Aulikki Nissinen, Brunner Ej, Eric J. Brunner, Kuller Lh, Lewis H. Kuller, Jackie F. Price, Price Jf, Johan Sundstrom, Matthew W. Knuiman, Knuiman Mw, Edith J. M. Feskens, Feskens Ej, W. M. M. Verschuren, Verschuren Wm, Nicholas Wald, Stephan J. L. Bakker, Peter H. Whincup, Bakker Sj, Ian Ford, Whincup Ph, Uri Goldbourt, Agustin Gomez-De-La-Camara, Agustín Gómez-De-La-Cámara, John Gallacher, Leon A. Simons, Simons La, Annika Rosengren, Susan E. Sutherland, Sutherland Se, Cecilia Bjorkelund, Blazer Dg, Dan G. Blazer, Sylvia Wassertheil-Smoller, Alejandro Marin Ibanez, Altan Onat, Alejandro Marín Ibañez, J. Wouter Jukema, Edoardo Casiglia, Jukema Jw, J. Wouter Jukema, Simpson Lm, Lara M. Simpson, Simona Giampaoli, Borge G. Nordestgaard, Nordestgaard Bg, Randi Selmer, Patrik Wennberg, Salonen Jt, Jussi Kauhanen, Ralph B. D'Agostino, Jukka T. Salonen, Rachel Dankner, Wallace Rb, Elizabeth Barrett-Connor, Maryam Kavousi, D'Agostino Rb, Vilmundur Gudnason, Umans Jg, Denis Evans, Robert B. Wallace, Gillum Rf, Mary Cushman, Ralph B. D’Agostino, Folsom Ar, Jason G. Umans, Yutaka Kiyohara, van der Schouw Yt, Hidaeki Nakagawa, Moons Kg, Shinichi Sato, Richard F. Gillum, Griffin Sj, Aaron R. Folsom, Yvonne T. van der Schouw, Wareham Nj, Karel G. Moons, Evin Ademoglu, Simon J. Griffin, Naveed Sattar, Thompson Sg, Nicholas J. Wareham, Elizabeth Selvin, Emerging Risk Factors, Simon G. Thompson, Emerging Risk Factors Collaboration, John Danesh, Eric HarshfieldORCID

Full text: Download

Publisher: Unknown publisher

Preprint: policy unknown. Upload

Postprint: policy unknown. Upload

Published version: policy unknown. Upload

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.