Hemoglobin A1c matters

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Hi All,

Hemoglobin A1c matters, according to the pdf-available free to all below

described

paper.

Update in Endocrinology

Leonard Wartofsky

Ann Intern Med. 2005 Nov 1;143(9):673-682

Hemoglobin A1c Should Be Considered an Independent and Progressive Risk Factor

for

Cardiovascular Disease

Khaw KT, Wareham N, Bingham S, et al. Association of hemoglobin A1c with

cardiovascular disease and mortality in adults: the European prospective

investigation into cancer in Norfolk. Ann Intern Med. 2004;141:413-20. [PMID:

15381514] [Abstract/Free Full Text]

http://www.annals.org/cgi/reprint/141/6/413.pdf

The aim of this study was to determine whether hemoglobin A1c levels are related

to

cardiovascular disease (CVD) and mortality and, consequently, whether

glycosylated

hemoglobin levels may serve as a predictor for cardiovascular events (5). The

authors used an ongoing prospective community-based study of 25 623 men and

women in

Norfolk, United Kingdom, to analyze this relationship in 4662 men and 5570

women.

Hemoglobin A1c levels averaged 8.0% in the participants with diabetes compared

with

5.3% in those without diabetes. An increase in hemoglobin A1c levels of 1

percentage

point (for example, from 7.0% to 8.0%) was associated with a statistically

significant increased risk for death from any cause (odds ratio, 1.26 [95% CI,

1.04

to 1.52]). This risk relationship was present at all levels of hemoglobin A1c

and

was independent of all other known risk factors, including diabetes. Of

importance,

individuals with hemoglobin A1c levels in the range of 5.0% to 6.9% accounted

for

more than 70% of the increased cardiovascular risk attributable to elevated

hemoglobin A1c levels.

The authors concluded that hemoglobin A1c is associated with a progressive and

continuous increase in risk for both cardiovascular disease and mortality across

the

entire range of hemoglobin A1c values. The study is unique because of the large

number of study participants (including many women) and indicates that the

threshold

level between " normal " and " abnormal " hemoglobin A1c levels should be revised

downward.

These data are important because they demonstrate that hemoglobin A1c level can

be

considered an independent and progressive risk factor for cardiovascular disease

in

diabetic patients. An increase in glycosylated hemoglobin A1c level of 1

percentage

point predicts a 20% to 30% average relative increase in frequency of

cardiovascular

events across the range of hemoglobin A1c levels in the study sample. The

meta-analysis performed by Selvin and coworkers (6) confirmed these findings.

Al Pater, PhD; email: old542000@...

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