Glycated Hemoglobin Better Than Fasting Glucose for Predicting Cardiovascular Risk
Glycated hemoglobin levels, especially above 6.0%, are better than fasting glucose for predicting long-term cardiovascular risk, the New England Journal of Medicine reports.
Researchers measured glycated hemoglobin and fasting glucose in some 11,000 adults without diabetes or cardiovascular disease and followed them for a median of 14 years. Compared with hemoglobin levels of 5.0% to 5.5%, higher values — especially above 6% — were associated with significantly increased risks for diabetes, coronary heart disease, and stroke. Associations between hemoglobin and all-cause mortality were also significant, but formed a J-shaped curve, with the lowest and highest levels being predictive of death.
These findings held true even after adjustment for fasting glucose.
The authors say their findings "may add to the evidence supporting the use of glycated hemoglobin as a diagnostic test for diabetes."
Researchers measured glycated hemoglobin and fasting glucose in some 11,000 adults without diabetes or cardiovascular disease and followed them for a median of 14 years. Compared with hemoglobin levels of 5.0% to 5.5%, higher values — especially above 6% — were associated with significantly increased risks for diabetes, coronary heart disease, and stroke. Associations between hemoglobin and all-cause mortality were also significant, but formed a J-shaped curve, with the lowest and highest levels being predictive of death.
These findings held true even after adjustment for fasting glucose.
The authors say their findings "may add to the evidence supporting the use of glycated hemoglobin as a diagnostic test for diabetes."
posted by vanwash at 9:01 PM
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Jan 16th 2011 5.0 and 5.1 A1c
Poor Glycemic Control Linked to Heart Failure in Patients with Type 1 Diabetes
Patients with type 1 diabetes who have poor glycemic control are at increased risk for heart failure, according to an industry-funded study in the Lancet.
Using Swedish health registries, researchers identified some 21,000 adults with type 1 diabetes (mean age, 39). During a median 9 years' follow-up, 3% of the patients experienced heart failure.
After multivariable adjustment, patients with a hemoglobin A1c level of 10.5% or above were more likely to develop heart failure, compared with those with a level below 6.5% (hazard ratio, 3.98). Each 1% increase in HbA1c was associated with a 30% increase in heart failure risk.
A commentator writes that the key message from this paper is that "tight control of glycemia in type 1 diabetes is essential." But for type 2 diabetes, he adds, "the emphasis ... should remain on tight control of lipids and blood pressure, with reasonable but not exaggerated efforts to control glycemia."
Physician's First Watch for June 27, 2011
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