糖化血红蛋白可预测非糖尿病女性患糖尿病的风险，但不能预测其患心血管疾病的风险。
Hemoglobin A1c predicts diabetes but not cardiovascular disease in nondiabetic women.
作者信息
Pradhan Aruna D, Rifai Nader, Buring Julie E, Ridker Paul M
机构信息
Center for Cardiovascular Disease Prevention, Division of Cardiovascular Medicine, VA Boston Medical Center, Boston, Mass, USA.
出版信息
Am J Med. 2007 Aug;120(8):720-7. doi: 10.1016/j.amjmed.2007.03.022.
BACKGROUND
Hemoglobin A1c (HbA1c) is a marker of cumulative glycemic exposure over the preceding 2- to 3-month period. Whether mild elevations of this biomarker provide prognostic information for development of clinically evident type 2 diabetes and cardiovascular disease among individuals at usual risk for these disorders is uncertain.
METHODS
We examined baseline HbA1c levels as a predictor of incident clinical diabetes and cardiovascular disease (nonfatal myocardial infarction, coronary revascularization procedure, ischemic stroke, or death from cardiovascular causes) in a prospective cohort study beginning in 1992 of 26,563 US female health professionals aged 45 years or more without diagnosed diabetes or vascular disease (median follow-up 10.1 years).
RESULTS
During follow-up, 1238 cases of diabetes and 684 cardiovascular events occurred. In age-adjusted analyses using quintiles of HbA1c, a risk gradient was observed for both incident diabetes and cardiovascular disease. After multivariable adjustment, HbA1c remained a strong predictor of diabetes but was no longer significantly associated with incident cardiovascular disease. In analyses of threshold effects, adjusted relative risks for incident diabetes in HbA1c categories of less than 5.0%, 5.0% to 5.4%, 5.5% to 5.9%, 6.0% to 6.4%, 6.5% to 6.9%, and 7.0% or more were 1.0, 2.9, 12.1, 29.3, 28.2, and 81.2, respectively. Risk associations persisted after additional adjustment for C-reactive protein and after excluding individuals developing diabetes within 2 and 5 years of follow-up.
CONCLUSIONS
These prospective findings suggest that HbA1c levels are elevated well in advance of the clinical development of type 2 diabetes, supporting recent recommendations for lowering of diagnostic thresholds for glucose metabolic disorders. In contrast, the association of HbA1c with incident cardiovascular events is modest and largely attributable to coexistent traditional risk factors.
背景
糖化血红蛋白（HbA1c）是前2至3个月期间累积血糖暴露的标志物。这种生物标志物的轻度升高是否能为通常有这些疾病风险的个体发生临床明显的2型糖尿病和心血管疾病提供预后信息尚不确定。
方法
在一项始于1992年的前瞻性队列研究中，我们检查了26563名年龄在45岁及以上、未诊断出患有糖尿病或血管疾病的美国女性健康专业人员（中位随访时间10.1年）的基线HbA1c水平，将其作为新发临床糖尿病和心血管疾病（非致命性心肌梗死、冠状动脉血运重建术、缺血性中风或心血管原因导致的死亡）的预测指标。
结果
在随访期间，发生了1238例糖尿病病例和684例心血管事件。在使用HbA1c五分位数进行年龄调整分析时，观察到新发糖尿病和心血管疾病均存在风险梯度。经过多变量调整后，HbA1c仍然是糖尿病的有力预测指标，但与新发心血管疾病不再有显著关联。在阈值效应分析中，HbA1c类别低于5.0%、5.0%至5.4%、5.5%至5.9%、6.0%至6.4%、6.5%至6.9%以及7.0%或更高时，新发糖尿病的调整后相对风险分别为1.0、2.9、12.1、29.3、28.2和81.2。在进一步调整C反应蛋白后以及排除随访2年和5年内发生糖尿病的个体后，风险关联仍然存在。
结论
这些前瞻性研究结果表明，HbA1c水平在2型糖尿病临床发展之前就已显著升高，支持了近期关于降低糖代谢紊乱诊断阈值的建议。相比之下，HbA1c与新发心血管事件的关联较小，且很大程度上归因于并存的传统风险因素。
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