Department of Endocrinology, the Central Hospital of Xuzhou, Xuzhou Clinical School of Xuzhou Medical College, Xuzhou, Jiangsu, China.
PLoS One. 2012;7(8):e38485. doi: 10.1371/journal.pone.0038485. Epub 2012 Aug 3.
The American Diabetes Association (ADA) recently published new clinical guidelines in which hemoglobin A1c (HbA1c) was recommended as a diagnostic test for diabetes. The present study was to investigate the association between HbA1c and cardiovascular risk, and compare the associations with fasting glucose and 2-hour oral glucose tolerance test (2 h OGTT).
The study samples are from a community-based health examination survey in central China. Carotid-to-femoral pulse wave velocity (cfPWV) and HbA1c were measured in 5,098 men and women.
After adjustment for age, sex, and BMI, the levels of HbA1c were significantly associated with an increasing trend of cfPWV in a dose-dependent fashion (P for trend <0.0001). The associations remained significant after further adjustment for blood pressure, heart rate, and lipids (P = 0.004), and the difference in cfPWV between the highest and the lowest quintiles of HbA1c was 0.31 m/s. Fasting glucose and 2 h OGTT were not associated with cfPWV in the multivariate analyses. HbA1c showed additive effects with fasting glucose or 2 h OGTT on cfPWV. In addition, age and blood pressure significantly modified the associations between HbA1c and cfPWV (P for interactions <0.0001 for age; and = 0.019 for blood pressure). The associations were stronger in subjects who were older (≥60 y; P for trend = 0.004) and had higher blood pressure (≥120 [systolic blood pressure]/80 mmHg [diastolic blood pressure]; P for trend = 0.028) than those who were younger and had lower blood pressure (P for trend >0.05).
HbA1c was related to high cfPWV, independent of conventional cardiovascular risk factors. Senior age and high blood pressure might amplify the adverse effects of HbA1c on cardiovascular risk.
美国糖尿病协会（ADA）最近发布了新的临床指南，其中建议将糖化血红蛋白（HbA1c）作为糖尿病的诊断检测方法。本研究旨在探讨 HbA1c 与心血管风险之间的关系，并比较其与空腹血糖和 2 小时口服葡萄糖耐量试验（2 h OGTT）的相关性。
本研究的样本来自中国中部一个社区为基础的健康检查调查。在 5098 名男性和女性中测量了颈动脉-股动脉脉搏波速度（cfPWV）和 HbA1c。
在校正年龄、性别和 BMI 后，HbA1c 水平与 cfPWV 呈剂量依赖性的递增趋势（趋势 P<0.0001）。在进一步校正血压、心率和血脂后，相关性仍然显著（P=0.004），HbA1c 最高和最低五分位之间的 cfPWV 差值为 0.31 m/s。空腹血糖和 2 h OGTT 在多元分析中与 cfPWV 无关。HbA1c 与空腹血糖或 2 h OGTT 对 cfPWV 有相加作用。此外，年龄和血压显著改变了 HbA1c 与 cfPWV 之间的相关性（年龄的交互作用 P<0.0001；血压的交互作用 P=0.019）。在年龄较大（≥60 岁；趋势 P=0.004）和血压较高（≥120 [收缩压]/80 mmHg [舒张压]）的受试者中，相关性更强（趋势 P<0.05）。
HbA1c 与高 cfPWV 相关，独立于传统心血管危险因素。高龄和高血压可能放大 HbA1c 对心血管风险的不良影响。
