Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo 105-8461, Japan.
Cardiovasc Diabetol. 2011 Jun 30;10:58. doi: 10.1186/1475-2840-10-58.
Although the ADA/EASD/IDF International Expert Committee recommends using hemoglobin A1c (HbA1c) to define diabetes, the relation between HbA1c and cardiovascular disease (CVD) has not been thoroughly investigated. We analyzed this relation using clinical data on Japanese individuals with hypercholesterolemia.
In the large-scale MEGA Study 7832 patients aged 40 to 70 years old with mild-to-moderate hypercholesterolemia without CVD were randomized to diet alone or diet plus pravastatin and followed for >5 years. In the present subanalysis of that study a total of 4002 patients with baseline and follow-up HbA1c data were stratified according to having an average HbA1c during the first year of follow-up <6.0%, 6.0%-<6.5%, or ≥ 6.5% and their subsequent 5-year incidence rates of CVD compared according to sex, low-density lipoprotein cholesterol (LDL-C), and treatment arm.
Overall, risk of CVD was significantly 2.4 times higher in individuals with HbA1c ≥ 6.5% versus <6.0%. A similar relation was noted in men and women (hazard ratio [HR], 2.1; p <0.01 and HR, 3.0; p <0.01, respectively) and was regardless of treatment arm (diet alone group: HR, 2.2; p <0.001; diet plus pravastatin group: HR, 1.8; p = 0.02). Spline curves showed a continuous risk increase according to HbA1c level in all subpopulations studied.
In hypercholesterolemic individuals the risk of CVD increases linearly with HbA1c level. This significant contribution by elevated HbA1c to increased CVD is independent of pravastatin therapy, and thus requires appropriate HbA1c management in addition to lipids reduction.
尽管 ADA/EASD/IDF 国际专家委员会建议使用糖化血红蛋白（HbA1c）来定义糖尿病，但 HbA1c 与心血管疾病（CVD）之间的关系尚未得到充分研究。我们使用患有高胆固醇血症的日本个体的临床数据对此关系进行了分析。
在大规模 MEGA 研究中，7832 名年龄在 40 至 70 岁之间、患有轻度至中度高胆固醇血症且无 CVD 的患者被随机分为单独饮食组或饮食加普伐他汀组，并随访超过 5 年。在该研究的本次亚分析中，共有 4002 名患者具有基线和随访 HbA1c 数据，根据第一年随访期间的平均 HbA1c<6.0%、6.0%-<6.5%或≥6.5%进行分层，并根据性别、低密度脂蛋白胆固醇（LDL-C）和治疗组比较其随后 5 年 CVD 的发生率。
总体而言，HbA1c≥6.5%的患者 CVD 风险明显高 2.4 倍。这种关系在男性和女性中均有观察到（风险比[HR]，2.1；p<0.01 和 HR，3.0；p<0.01），且与治疗组无关（单独饮食组：HR，2.2；p<0.001；饮食加普伐他汀组：HR，1.8；p=0.02）。折线图显示，在所有研究的亚人群中，HbA1c 水平与风险呈线性增加。
在高胆固醇血症患者中，CVD 风险随 HbA1c 水平线性增加。HbA1c 升高对 CVD 增加的显著贡献独立于普伐他汀治疗，因此除了降低血脂外，还需要适当的 HbA1c 管理。
