Association of glycated hemoglobin A1c levels with cardiovascular outcomes in the general population: results from the BiomarCaRE (Biomarker for Cardiovascular Risk Assessment in Europe) consortium

Abstract Background Biomarkers may contribute to improved cardiovascular risk estimation. Glycated hemoglobin A1c (HbA1c) is used to monitor the quality of diabetes treatment. Its strength of association with cardiovascular outcomes in the general population remains uncertain. This study aims to ass...

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Autores principales:	Christoph Sinning, Nataliya Makarova, Henry Völzke, Renate B. Schnabel, Francisco Ojeda, Marcus Dörr, Stephan B. Felix, Wolfgang Koenig, Annette Peters, Wolfgang Rathmann, Ben Schöttker, Hermann Brenner, Giovanni Veronesi, Giancarlo Cesana, Paolo Brambilla, Tarja Palosaari, Kari Kuulasmaa, Inger Njølstad, Ellisiv Bøgeberg Mathiesen, Tom Wilsgaard, Stefan Blankenberg, Stefan Söderberg, Marco M. Ferrario, Barbara Thorand
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Biomarkers Glycated hemoglobin A1c (HbA1c) Cardiovascular risk Mortality BiomarCaRE (Biomarker for Cardiovascular Risk Assessment in Europe) MORGAM (MONICA Risk Genetics Archiving and Monograph) Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/9731035e63df4338aefbcedd86a46c91
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spelling	oai:doaj.org-article:9731035e63df4338aefbcedd86a46c912021-11-21T12:14:29ZAssociation of glycated hemoglobin A1c levels with cardiovascular outcomes in the general population: results from the BiomarCaRE (Biomarker for Cardiovascular Risk Assessment in Europe) consortium10.1186/s12933-021-01413-41475-2840https://doaj.org/article/9731035e63df4338aefbcedd86a46c912021-11-01T00:00:00Zhttps://doi.org/10.1186/s12933-021-01413-4https://doaj.org/toc/1475-2840Abstract Background Biomarkers may contribute to improved cardiovascular risk estimation. Glycated hemoglobin A1c (HbA1c) is used to monitor the quality of diabetes treatment. Its strength of association with cardiovascular outcomes in the general population remains uncertain. This study aims to assess the association of HbA1c with cardiovascular outcomes in the general population. Methods Data from six prospective population-based cohort studies across Europe comprising 36,180 participants were analyzed. HbA1c was evaluated in conjunction with classical cardiovascular risk factors (CVRFs) for association with cardiovascular mortality, cardiovascular disease (CVD) incidence, and overall mortality in subjects without diabetes (N = 32,496) and with diabetes (N = 3684). Results Kaplan–Meier curves showed higher event rates with increasing HbA1c levels (log-rank-test: p < 0.001). Cox regression analysis revealed significant associations between HbA1c (in mmol/mol) in the total study population and the examined outcomes. Thus, a hazard ratio (HR) of 1.16 (95% confidence interval (CI) 1.02–1.31, p = 0.02) for cardiovascular mortality, 1.13 (95% CI 1.03–1.24, p = 0.01) for CVD incidence, and 1.09 (95% CI 1.02–1.17, p = 0.01) for overall mortality was observed per 10 mmol/mol increase in HbA1c. The association with CVD incidence and overall mortality was also observed in study participants without diabetes with increased HbA1c levels (HR 1.12; 95% CI 1.01–1.25, p = 0.04) and HR 1.10; 95% CI 1.01–1.20, p = 0.02) respectively. HbA1c cut-off values of 39.9 mmol/mol (5.8%), 36.6 mmol/mol (5.5%), and 38.8 mmol/mol (5.7%) for cardiovascular mortality, CVD incidence, and overall mortality, showed also an increased risk. Conclusions HbA1c is independently associated with cardiovascular mortality, overall mortality and cardiovascular disease in the general European population. A mostly monotonically increasing relationship was observed between HbA1c levels and outcomes. Elevated HbA1c levels were associated with cardiovascular disease incidence and overall mortality in participants without diabetes underlining the importance of HbA1c levels in the overall population.Christoph SinningNataliya MakarovaHenry VölzkeRenate B. SchnabelFrancisco OjedaMarcus DörrStephan B. FelixWolfgang KoenigAnnette PetersWolfgang RathmannBen SchöttkerHermann BrennerGiovanni VeronesiGiancarlo CesanaPaolo BrambillaTarja PalosaariKari KuulasmaaInger NjølstadEllisiv Bøgeberg MathiesenTom WilsgaardStefan BlankenbergStefan SöderbergMarco M. FerrarioBarbara ThorandBMCarticleBiomarkersGlycated hemoglobin A1c (HbA1c)Cardiovascular riskMortalityBiomarCaRE (Biomarker for Cardiovascular Risk Assessment in Europe)MORGAM (MONICA Risk Genetics Archiving and Monograph)Diseases of the circulatory (Cardiovascular) systemRC666-701ENCardiovascular Diabetology, Vol 20, Iss 1, Pp 1-13 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Biomarkers Glycated hemoglobin A1c (HbA1c) Cardiovascular risk Mortality BiomarCaRE (Biomarker for Cardiovascular Risk Assessment in Europe) MORGAM (MONICA Risk Genetics Archiving and Monograph) Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	Biomarkers Glycated hemoglobin A1c (HbA1c) Cardiovascular risk Mortality BiomarCaRE (Biomarker for Cardiovascular Risk Assessment in Europe) MORGAM (MONICA Risk Genetics Archiving and Monograph) Diseases of the circulatory (Cardiovascular) system RC666-701 Christoph Sinning Nataliya Makarova Henry Völzke Renate B. Schnabel Francisco Ojeda Marcus Dörr Stephan B. Felix Wolfgang Koenig Annette Peters Wolfgang Rathmann Ben Schöttker Hermann Brenner Giovanni Veronesi Giancarlo Cesana Paolo Brambilla Tarja Palosaari Kari Kuulasmaa Inger Njølstad Ellisiv Bøgeberg Mathiesen Tom Wilsgaard Stefan Blankenberg Stefan Söderberg Marco M. Ferrario Barbara Thorand Association of glycated hemoglobin A1c levels with cardiovascular outcomes in the general population: results from the BiomarCaRE (Biomarker for Cardiovascular Risk Assessment in Europe) consortium
description	Abstract Background Biomarkers may contribute to improved cardiovascular risk estimation. Glycated hemoglobin A1c (HbA1c) is used to monitor the quality of diabetes treatment. Its strength of association with cardiovascular outcomes in the general population remains uncertain. This study aims to assess the association of HbA1c with cardiovascular outcomes in the general population. Methods Data from six prospective population-based cohort studies across Europe comprising 36,180 participants were analyzed. HbA1c was evaluated in conjunction with classical cardiovascular risk factors (CVRFs) for association with cardiovascular mortality, cardiovascular disease (CVD) incidence, and overall mortality in subjects without diabetes (N = 32,496) and with diabetes (N = 3684). Results Kaplan–Meier curves showed higher event rates with increasing HbA1c levels (log-rank-test: p < 0.001). Cox regression analysis revealed significant associations between HbA1c (in mmol/mol) in the total study population and the examined outcomes. Thus, a hazard ratio (HR) of 1.16 (95% confidence interval (CI) 1.02–1.31, p = 0.02) for cardiovascular mortality, 1.13 (95% CI 1.03–1.24, p = 0.01) for CVD incidence, and 1.09 (95% CI 1.02–1.17, p = 0.01) for overall mortality was observed per 10 mmol/mol increase in HbA1c. The association with CVD incidence and overall mortality was also observed in study participants without diabetes with increased HbA1c levels (HR 1.12; 95% CI 1.01–1.25, p = 0.04) and HR 1.10; 95% CI 1.01–1.20, p = 0.02) respectively. HbA1c cut-off values of 39.9 mmol/mol (5.8%), 36.6 mmol/mol (5.5%), and 38.8 mmol/mol (5.7%) for cardiovascular mortality, CVD incidence, and overall mortality, showed also an increased risk. Conclusions HbA1c is independently associated with cardiovascular mortality, overall mortality and cardiovascular disease in the general European population. A mostly monotonically increasing relationship was observed between HbA1c levels and outcomes. Elevated HbA1c levels were associated with cardiovascular disease incidence and overall mortality in participants without diabetes underlining the importance of HbA1c levels in the overall population.
format	article
author	Christoph Sinning Nataliya Makarova Henry Völzke Renate B. Schnabel Francisco Ojeda Marcus Dörr Stephan B. Felix Wolfgang Koenig Annette Peters Wolfgang Rathmann Ben Schöttker Hermann Brenner Giovanni Veronesi Giancarlo Cesana Paolo Brambilla Tarja Palosaari Kari Kuulasmaa Inger Njølstad Ellisiv Bøgeberg Mathiesen Tom Wilsgaard Stefan Blankenberg Stefan Söderberg Marco M. Ferrario Barbara Thorand
author_facet	Christoph Sinning Nataliya Makarova Henry Völzke Renate B. Schnabel Francisco Ojeda Marcus Dörr Stephan B. Felix Wolfgang Koenig Annette Peters Wolfgang Rathmann Ben Schöttker Hermann Brenner Giovanni Veronesi Giancarlo Cesana Paolo Brambilla Tarja Palosaari Kari Kuulasmaa Inger Njølstad Ellisiv Bøgeberg Mathiesen Tom Wilsgaard Stefan Blankenberg Stefan Söderberg Marco M. Ferrario Barbara Thorand
author_sort	Christoph Sinning
title	Association of glycated hemoglobin A1c levels with cardiovascular outcomes in the general population: results from the BiomarCaRE (Biomarker for Cardiovascular Risk Assessment in Europe) consortium
title_short	Association of glycated hemoglobin A1c levels with cardiovascular outcomes in the general population: results from the BiomarCaRE (Biomarker for Cardiovascular Risk Assessment in Europe) consortium
title_full	Association of glycated hemoglobin A1c levels with cardiovascular outcomes in the general population: results from the BiomarCaRE (Biomarker for Cardiovascular Risk Assessment in Europe) consortium
title_fullStr	Association of glycated hemoglobin A1c levels with cardiovascular outcomes in the general population: results from the BiomarCaRE (Biomarker for Cardiovascular Risk Assessment in Europe) consortium
title_full_unstemmed	Association of glycated hemoglobin A1c levels with cardiovascular outcomes in the general population: results from the BiomarCaRE (Biomarker for Cardiovascular Risk Assessment in Europe) consortium
title_sort	association of glycated hemoglobin a1c levels with cardiovascular outcomes in the general population: results from the biomarcare (biomarker for cardiovascular risk assessment in europe) consortium
publisher	BMC
publishDate	2021
url	https://doaj.org/article/9731035e63df4338aefbcedd86a46c91
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Association of glycated hemoglobin A1c levels with cardiovascular outcomes in the general population: results from the BiomarCaRE (Biomarker for Cardiovascular Risk Assessment in Europe) consortium

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