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Association of glycated hemoglobin A(1c) levels with cardiovascular outcomes in the general population: results from the BiomarCaRE (Biomarker for Cardiovascular Risk Assessment in Europe) consortium

BACKGROUND: Biomarkers may contribute to improved cardiovascular risk estimation. Glycated hemoglobin A(1c) (HbA(1c)) 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...

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Autores principales: Sinning, Christoph, 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, Barbara
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8594211/
https://www.ncbi.nlm.nih.gov/pubmed/34781939
http://dx.doi.org/10.1186/s12933-021-01413-4
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author Sinning, Christoph
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, Barbara
author_facet Sinning, Christoph
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, Barbara
author_sort Sinning, Christoph
collection PubMed
description BACKGROUND: Biomarkers may contribute to improved cardiovascular risk estimation. Glycated hemoglobin A(1c) (HbA(1c)) 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 HbA(1c) with cardiovascular outcomes in the general population. METHODS: Data from six prospective population-based cohort studies across Europe comprising 36,180 participants were analyzed. HbA(1c) 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 HbA(1c) levels (log-rank-test: p < 0.001). Cox regression analysis revealed significant associations between HbA(1c) (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 HbA(1c). The association with CVD incidence and overall mortality was also observed in study participants without diabetes with increased HbA(1c) 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. HbA(1c) 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: HbA(1c) is independently associated with cardiovascular mortality, overall mortality and cardiovascular disease in the general European population. A mostly monotonically increasing relationship was observed between HbA(1c) levels and outcomes. Elevated HbA(1c) levels were associated with cardiovascular disease incidence and overall mortality in participants without diabetes underlining the importance of HbA(1c) levels in the overall population. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12933-021-01413-4.
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spelling pubmed-85942112021-11-16 Association of glycated hemoglobin A(1c) levels with cardiovascular outcomes in the general population: results from the BiomarCaRE (Biomarker for Cardiovascular Risk Assessment in Europe) consortium Sinning, Christoph 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, Barbara Cardiovasc Diabetol Original Investigation BACKGROUND: Biomarkers may contribute to improved cardiovascular risk estimation. Glycated hemoglobin A(1c) (HbA(1c)) 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 HbA(1c) with cardiovascular outcomes in the general population. METHODS: Data from six prospective population-based cohort studies across Europe comprising 36,180 participants were analyzed. HbA(1c) 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 HbA(1c) levels (log-rank-test: p < 0.001). Cox regression analysis revealed significant associations between HbA(1c) (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 HbA(1c). The association with CVD incidence and overall mortality was also observed in study participants without diabetes with increased HbA(1c) 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. HbA(1c) 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: HbA(1c) is independently associated with cardiovascular mortality, overall mortality and cardiovascular disease in the general European population. A mostly monotonically increasing relationship was observed between HbA(1c) levels and outcomes. Elevated HbA(1c) levels were associated with cardiovascular disease incidence and overall mortality in participants without diabetes underlining the importance of HbA(1c) levels in the overall population. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12933-021-01413-4. BioMed Central 2021-11-15 /pmc/articles/PMC8594211/ /pubmed/34781939 http://dx.doi.org/10.1186/s12933-021-01413-4 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Original Investigation
Sinning, Christoph
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, Barbara
Association of glycated hemoglobin A(1c) levels with cardiovascular outcomes in the general population: results from the BiomarCaRE (Biomarker for Cardiovascular Risk Assessment in Europe) consortium
title Association of glycated hemoglobin A(1c) levels with cardiovascular outcomes in the general population: results from the BiomarCaRE (Biomarker for Cardiovascular Risk Assessment in Europe) consortium
title_full Association of glycated hemoglobin A(1c) levels with cardiovascular outcomes in the general population: results from the BiomarCaRE (Biomarker for Cardiovascular Risk Assessment in Europe) consortium
title_fullStr Association of glycated hemoglobin A(1c) levels with cardiovascular outcomes in the general population: results from the BiomarCaRE (Biomarker for Cardiovascular Risk Assessment in Europe) consortium
title_full_unstemmed Association of glycated hemoglobin A(1c) levels with cardiovascular outcomes in the general population: results from the BiomarCaRE (Biomarker for Cardiovascular Risk Assessment in Europe) consortium
title_short Association of glycated hemoglobin A(1c) levels with cardiovascular outcomes in the general population: results from the BiomarCaRE (Biomarker for Cardiovascular Risk Assessment in Europe) consortium
title_sort association of glycated hemoglobin a(1c) levels with cardiovascular outcomes in the general population: results from the biomarcare (biomarker for cardiovascular risk assessment in europe) consortium
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8594211/
https://www.ncbi.nlm.nih.gov/pubmed/34781939
http://dx.doi.org/10.1186/s12933-021-01413-4
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