Hemoglobin A1c Levels and the Risk of Cardiovascular Disease in People Without Known Diabetes A Population-Based Cohort Study in Japan

被引：31

作者：

Goto, Atsushi ^{[1
,2
]}

Noda, Mitsuhiko ^{[1
]}

Matsushita, Yumi ^{[3
]}

Goto, Maki ^{[1
]}

Kato, Masayuki ^{[1
]}

Isogawa, Akihiro ^{[5
]}

Takahashi, Yoshihiko ^{[6
]}

Kurotani, Kayo ^{[4
]}

Oba, Shino ^{[7
]}

Nanri, Akiko ^{[4
]}

Mizoue, Tetsuya ^{[4
]}

Yamagishi, Kazumasa ^{[8
]}

Yatsuya, Hiroshi ^{[9
]}

Saito, Isao ^{[10
]}

Kokubo, Yoshihiro ^{[11
]}

Sawada, Norie ^{[12
]}

Inoue, Manami ^{[13
]}

Iso, Hiroyasu ^{[15
]}

Kadowaki, Takashi ^{[14
]}

Tsugane, Shoichiro ^{[12
]}

机构：

[1] Natl Ctr Global Hlth & Med, Dept Diabet Res, Diabet Res Ctr, Tokyo 1628655, Japan

[2] Tokyo Womens Med Univ, Dept Publ Hlth, Tokyo, Japan

[3] Natl Ctr Global Hlth & Med, Dept Clin Res, Tokyo 1628655, Japan

[4] Natl Ctr Global Hlth & Med, Dept Epidemiol & Prevent, Tokyo 1628655, Japan

[5] Mitsui Mem Hosp, Dept Internal Med, Tokyo 101, Japan

[6] Iwate Med Univ, Sch Med, Div Diabet & Metab, Morioka, Iwate, Japan

[7] Natl Inst Publ Hlth, Dept Hlth Promot, Saitama, Japan

[8] Univ Tsukuba, Dept Publ Hlth Med, Fac Med, Ibaraki, Japan

[9] Fujita Hlth Univ, Dept Publ Hlth, Toyoake, Aichi, Japan

[10] Ehime Univ, Dept Basic Nursing & Hlth Sci, Grad Sch Med, Matsuyama, Ehime 790, Japan

[11] Natl Cerebral & Cardiovasc Ctr, Dept Prevent Cardiol, Osaka, Japan

[12] Natl Canc Ctr, Res Ctr Canc Prevent & Screening, Epidemiol & Prevent Grp, Tokyo 104, Japan

[13] Univ Tokyo, Grad Sch Med, AXA Dept Hlth & Human Secur, Tokyo, Japan

[14] Univ Tokyo, Grad Sch Med, Diabet & Metab Dis, Tokyo, Japan

[15] Osaka Univ, Grad Sch Med, Publ Hlth, Dept Social & Environm Med, Osaka, Japan

来源：

MEDICINE | 2015年 / 94卷 / 17期

关键词：

CORONARY-HEART-DISEASE; ALL-CAUSE; GLYCATED HEMOGLOBIN; MORTALITY; HBA(1C); ASSOCIATION; STROKE; ADULTS; A1C; COMPLICATIONS;

D O I：

10.1097/MD.0000000000000785

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

High hemoglobin A(1c) (HbA(1c)) levels are strongly associated with an increased risk of cardiovascular disease (CVD) in people with and without diabetes. However, information regarding the relationship between low HbA(1c) levels and the risk of CVD among people without known diabetes is limited. The aim of this large-scale, prospective, population-based cohort study was to clarify the association between HbA(1c) levels and CVD risk among people without known diabetes. We followed-up 10,980 men and 18,079 women (46-80 years old and free of CVD and cancer at baseline) in the Japan Public Health Center-based Prospective Study. Using Cox models, we estimated the hazard ratios for CVD risk with adjustments for age, sex, geographic areas, body mass index, smoking status, sports and physical exercise, alcohol intake, systolic blood pressure, non-high-density lipoprotein cholesterol, and high-density lipoprotein cholesterol. During the median follow-up of 9.4 years, 935 CVD events (770 strokes and 165 coronary heart diseases) occurred. We observed a nonlinear association between HbA(1c) levels and CVD risk in participants without known diabetes. Compared with HbA(1c) levels of 5.0 to 5.4% (31-36 mmol/mol), the hazard ratios for CVD in participants without known diabetes were 1.50 (95% confidence interval: 1.151.95), 1.01 (0.85-1.20), 1.04 (0.82-1.32), and 1.77 (1.32-2.38) for HbA(1c) levels of < 5.0% (< 31 mmol/mol), 5.5 to 5.9% (37-41 mmol/mol), 6.0 to 6.4% (42-47 mmol/mol), and >= 6.5% (>= 48 mmol/mol), respectively (P value for nonlinear trend: < 0.001). In addition, the hazard ratio for CVD was 1.81 (1.43-2.29) in patients with known diabetes compared with participants with HbA(1c) levels of 5.0 to 5.4% and without known diabetes. This nonlinear relation persisted after excluding people with kidney dysfunction, liver dysfunction, anemia, body mass index <18.5 kg/m(2), or early events within 3 years of followup (P value for nonlinear trend: < 0.01 for all tests). In conclusion, both low and high levels of HbA(1c) were associated with a higher risk of CVD in a Japanese general population without known diabetes.

引用

页数：10

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