Glycated Hemoglobin Measurement and Prediction of Cardiovascular Disease

被引：175

作者：

Di Angelantonio, Emanuele ^{[1
]}

Gao, Pei ^{[1
]}

Khan, Hassan ^{[1
]}

Butterworth, Adam S. ^{[1
]}

Wormser, David ^{[1
]}

Kaptoge, Stephen ^{[1
]}

Seshasai, Sreenivasa Rao Kondapally ^{[2
]}

Thompson, Alex ^{[1
]}

Sarwar, Nadeem ^{[1
]}

Willeit, Peter ^{[1
]}

Ridker, Paul M. ^{[3
]}

Barr, Elizabeth L. M. ^{[4
]}

Khaw, Kay-Tee ^{[1
]}

Psaty, Bruce M. ^{[5
,6
]}

Brenner, Hermann ^{[7
]}

Balkau, Beverley ^{[8
,9
]}

Dekker, Jacqueline M. ^{[10
]}

Lawlor, Debbie A. ^{[11
]}

Daimon, Makoto ^{[12
]}

Willeit, Johann ^{[13
]}

Njolstad, Inger ^{[14
]}

Nissinen, Aulikki ^{[15
]}

Brunner, Eric J. ^{[16
]}

Kuller, Lewis H. ^{[17
]}

Price, Jackie F. ^{[18
]}

Sundstrom, Johan ^{[19
]}

Knuiman, Matthew W. ^{[20
]}

Feskens, Edith J. M. ^{[21
]}

Verschuren, W. M. M. ^{[22
]}

Wald, Nicholas ^{[23
]}

Bakker, Stephan J. L. ^{[24
]}

Whincup, Peter H. ^{[2
]}

Ford, Ian ^{[25
]}

Goldbourt, Uri ^{[26
]}

Gomez-de-la-Camara, Agustin ^{[27
]}

Gallacher, John ^{[28
]}

Simons, Leon A. ^{[29
]}

Rosengren, Annika ^{[30
]}

Sutherland, Susan E. ^{[31
]}

Bjorkelund, Cecilia ^{[32
]}

Blazer, Dan G. ^{[33
]}

Wassertheil-Smoller, Sylvia ^{[34
]}

Onat, Altan ^{[35
]}

Ibanez, Alejandro Marin ^{[36
]}

Casiglia, Edoardo ^{[37
]}

Jukema, J. Wouter ^{[38
]}

Simpson, Lara M. ^{[39
]}

Giampaoli, Simona ^{[40
]}

Nordestgaard, Borge G. ^{[41
]}

Selmer, Randi ^{[42
]}

机构：

[1] Univ Cambridge, Cambridge, England

[2] St Georges Univ London, London, England

[3] Brigham & Womens Hosp, Boston, MA 02115 USA

[4] Baker IDI Heart & Diabet Inst, Melbourne, Vic, Australia

[5] Univ Washington, Seattle, WA 98195 USA

[6] Grp Hlth Res Inst, Seattle, WA USA

[7] German Canc Res Ctr, Heidelberg, Germany

[8] INSERM, Villejuif, France

[9] Univ Paris Sud, Villejuif, France

[10] Vrije Univ Med Ctr, Amsterdam, Netherlands

[11] Univ Bristol, Bristol, Avon, England

[12] Yamagata Univ, Yamagata 990, Japan

[13] Med Univ Innsbruck, A-6020 Innsbruck, Austria

[14] Univ Tromso, Tromso, Norway

[15] Natl Inst Hlth & Welf, Helsinki, Finland

[16] UCL, London, England

[17] Univ Pittsburgh, Pittsburgh, PA 15260 USA

[18] Univ Edinburgh, Edinburgh, Midlothian, Scotland

[19] Uppsala Univ, Uppsala, Sweden

[20] Univ Western Australia, Perth, WA 6009, Australia

[21] Wageningen Univ, NL-6700 AP Wageningen, Netherlands

[22] Natl Inst Publ Hlth & Environm RIVM, NL-3720 BA Bilthoven, Netherlands

[23] Wolfson Inst Prevent Med, London, England

[24] Univ Groningen, Univ Med Ctr Groningen, NL-9700 AB Groningen, Netherlands

[25] Univ Glasgow, Glasgow, Lanark, Scotland

[26] Chaim Sheba Med Ctr, IL-52621 Tel Hashomer, Israel

[27] Hosp 12 Octubre, E-28041 Madrid, Spain

[28] Cardiff Univ, Cardiff CF10 3AX, S Glam, Wales

[29] Univ New S Wales, Kensington, NSW 2033, Australia

[30] Univ Gothenburg, Sahlgrenska Acad, Gothenburg, Sweden

[31] Med Univ S Carolina, Charleston, SC USA

[32] Univ Gothenburg, Gothenburg, Sweden

[33] Duke Univ, Med Ctr, Durham, NC USA

[34] Albert Einstein Coll Med, New York, NY USA

[35] Istanbul Univ, Istanbul, Turkey

[36] San Jose Norte Hlth Ctr, Zaragoza, Spain

[37] Univ Padua, Padua, Italy

[38] Leiden Univ, Med Ctr, Leiden, Netherlands

[39] Univ Texas Sch Publ Hlth, Houston, TX USA

[40] Ist Super Sanita, I-00161 Rome, Italy

[41] Univ Copenhagen, Herlev Hosp, Copenhagen Univ Hosp, Copenhagen, Denmark

[42] Norwegian Inst Publ Hlth, Oslo, Norway

[43] Umea Univ, Umea, Sweden

[44] Univ Eastern Finland, Kuopio, Finland

[45] Univ Helsinki, Helsinki, Finland

[46] Gertner Inst Epidemiol & Hlth Policy Res, Tel Hashomer, Israel

[47] Tel Aviv Univ, IL-69978 Tel Aviv, Israel

[48] Feinstein Inst Med Res, New York, NY USA

[49] Univ Calif San Diego, San Diego, CA 92103 USA

[50] Erasmus MC, Rotterdam, Netherlands

来源：

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2014年 / 311卷 / 12期

基金：

英国医学研究理事会;

关键词：

STATISTICAL-METHODS; RISK; GLUCOSE; GUIDELINES;

D O I：

10.1001/jama.2014.1873

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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 (<5%), intermediate (5% to <7.5%), and high (>= 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.

引用

页码：1225 / 1233

页数：9

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