Journal article
Glycated hemoglobin measurement and prediction of cardiovascular disease
JAMA : the journal of the American Medical Association, Vol.311(12), pp.1225-1233
03/26/2014
DOI: 10.1001/jama.2014.1873
PMCID: PMC4386007
PMID: 24668104
Abstract
The value of measuring levels of glycated hemoglobin (HbA1c) for the prediction of first cardiovascular events is uncertain.
To determine whether adding information on HbA1c values to conventional cardiovascular risk factors is associated with improvement in prediction of cardiovascular disease (CVD) risk.
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.
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 (<5%), intermediate (5% to <7.5%), and high (≥ 7.5%) risk.
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 HbA1c values and CVD risk. The association between HbA1c 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 HbA1c 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 HbA1c assessment in prediction of CVD risk was equal to or better than estimated improvements for measurement of fasting, random, or postload plasma glucose levels.
In a study of individuals without known CVD or diabetes, additional assessment of HbA1c values in the context of CVD risk assessment provided little incremental benefit for prediction of CVD risk.
Details
- Title: Subtitle
- Glycated hemoglobin measurement and prediction of cardiovascular disease
- Creators
- Emanuele Di Angelantonio - University of CambridgePei Gao - University of CambridgeHassan Khan - University of CambridgeAdam S Butterworth - University of CambridgeDavid Wormser - University of CambridgeStephen Kaptoge - University of CambridgeSreenivasa Rao Kondapally Seshasai - St George's, University of LondonAlex Thompson - University of CambridgeNadeem Sarwar - University of CambridgePeter Willeit - University of CambridgePaul M Ridker - Harvard UniversityElizabeth L M Barr - The Heart Research InstituteKay-Tee Khaw - University of CambridgeBruce M Psaty - Group Health CooperativeHermann Brenner - German Cancer Research CenterBeverley Balkau - Université Paris-SudJacqueline M Dekker - InsermDebbie A Lawlor - University of BristolMakoto Daimon - Yamagata UniversityJohann Willeit - Innsbruck Medical UniversityInger Njølstad - University of Tromsø, Tromsø, NorwayAulikki Nissinen - National Institute of Health and Welfare, Helsinki, FinlandEric J Brunner - University College LondonLewis H Kuller - University of PittsburghJackie F Price - University of EdinburghJohan Sundström - Uppsala UniversityMatthew W Knuiman - The University of Western AustraliaEdith J M Feskens - The University of Western AustraliaW M M Verschuren - National Institute for Public Health and the Environment (RIVM), Bilthoven, the NetherlandsNicholas Wald - Queen Mary University of LondonStephan J L Bakker - University of GroningenPeter H Whincup - St George's, University of LondonIan Ford - University of GlasgowUri Goldbourt - Sheba Medical CenterAgustín Gómez-de-la-Cámara - Sheba Medical CenterJohn Gallacher - Cardiff UniversityLeon A Simons - UNSW SydneyAnnika Rosengren - University of GothenburgSusan E Sutherland - Medical University of South CarolinaCecilia Björkelund - University of GothenburgDan G Blazer - Duke UniversitySylvia Wassertheil-Smoller - Yeshiva UniversityAltan Onat - Istanbul UniversityAlejandro Marín Ibañez - San Jose Norte Health Centre, Zaragoza, SpainEdoardo Casiglia - University of PaduaJ Wouter Jukema - Leiden UniversityLara M Simpson - The University of Texas Health Science Center at HoustonSimona Giampaoli - Istituto Superiore di SanitàBørge G Nordestgaard - University of CopenhagenRandi Selmer - Norwegian Institute of Public HealthPatrik Wennberg - Umeå UniversityJussi Kauhanen - University of Eastern FinlandJukka T Salonen - University of HelsinkiRachel Dankner - Northwell HealthElizabeth Barrett-Connor - University of California San DiegoMaryam Kavousi - Erasmus University RotterdamVilmundur Gudnason - University of IcelandDenis Evans - Rush University Medical CenterRobert B Wallace - University of IowaMary Cushman - University of VermontRalph B. D'Agostino Sr - Boston UniversityJason G Umans - Georgetown UniversityYutaka Kiyohara - Kyushu UniversityHidaeki Nakagawa - Kanazawa Medical UniversityShinichi Sato - Osaka Medical Center for Health Science and Promotion/Chiba Prefectural Institute of Public Health, Osaka, JapanRichard F Gillum - Howard UniversityAaron R Folsom - Howard UniversityYvonne T van der Schouw - Utrecht UniversityKarel G Moons - Utrecht UniversitySimon J Griffin - University of CambridgeNaveed Sattar - University of GlasgowNicholas J Wareham - University of CambridgeElizabeth Selvin - Johns Hopkins UniversitySimon G Thompson - University of CambridgeJohn Danesh - University of CambridgeEmerging Risk Factors Collaboration
- Resource Type
- Journal article
- Publication Details
- JAMA : the journal of the American Medical Association, Vol.311(12), pp.1225-1233
- DOI
- 10.1001/jama.2014.1873
- PMID
- 24668104
- PMCID
- PMC4386007
- NLM abbreviation
- JAMA
- ISSN
- 0098-7484
- eISSN
- 1538-3598
- Grant note
- G0401527 / Medical Research Council MC_UU_12013/5 / Medical Research Council MC_U106179474 / Medical Research Council MC_UU_12015/4 / Medical Research Council PG/13/66/30442 / British Heart Foundation RG/08/013/25942 / British Heart Foundation MR/L003120/1 / Medical Research Council UL1 TR000062 / NCATS NIH HHS MR/K013351/1 / Medical Research Council RG/13/2/30098 / British Heart Foundation RG/08/014/24067 / British Heart Foundation G1000143 / Medical Research Council RG/13/16/30528 / British Heart Foundation
- Language
- English
- Date published
- 03/26/2014
- Academic Unit
- Epidemiology; Injury Prevention Research Center; Internal Medicine
- Record Identifier
- 9984364436302771
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