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Glycated haemoglobin and the risk of cardiovascular disease, diabetes and all‐cause mortality in the C openhagen C ity H eart S tudy
Author(s) -
Eskesen K.,
Jensen M. T.,
Galatius S.,
Vestergaard H.,
Hildebrandt P.,
Marott J. L.,
Jensen J. S.
Publication year - 2013
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1111/j.1365-2796.2012.02594.x
Subject(s) - medicine , diabetes mellitus , hazard ratio , population , prospective cohort study , univariate analysis , gastroenterology , disease , endocrinology , multivariate analysis , confidence interval , environmental health
Objective Individuals with diabetes mellitus ( DM ) have a considerably elevated risk of developing serious health problems including cardiovascular disease ( CVD ). Long‐term elevated levels of blood glucose in nondiabetic individuals may also be associated with increased risk of CVD . The aim of this study was to investigate the relationships between glycated haemoglobin A 1c ( H b A 1c ) and CVD , DM and all‐cause mortality. Subjects and design The C openhagen C ity H eart S tudy is a prospective study of individuals from the D anish general population. The cohort was followed for 10 years via national registers with respect to incident CVD , DM and all‐cause mortality. Follow‐up was 100% complete. Results A total of 5127 subjects were included, of whom 597 had DM . In the nondiabetic population, H b A 1c was significantly associated with incident CVD events in both univariate [hazard ratio ( HR ) 1.38, 95% CI 1.11–1.71] and multivariate analyses ( HR 1.31, 95% CI 1.05–1.64). In the nondiabetic population, increased levels of H b A 1c were correlated with developing DM . There was a threefold increase in risk of incident DM per unit increase in H b A 1c with a univariate HR of 3.83 (95% CI 1.96–7.51). This relationship was essentially unchanged after multivariate adjustments ( HR 4.19, 95% CI 2.01–8.71). Furthermore, we found that net reclassification improvement for diagnosed DM and CVD was significantly improved with the addition of HbA 1c in the analyses. Although not statistically significant, we found a strong trend towards an association between H b A 1c and all‐cause mortality ( HR 1.21, 95% CI 0.99–1.47). We did not find the same associations amongst the population with DM . Conclusion In the D anish general population, H b A 1c was strongly associated with CVD in individuals without DM .