Ashraf Haleh, Boroumand Mohammad Ali, Amirzadegan Alireza, Talesh Shaghayegh Ashraf, Davoodi Gholamreza
Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, North Kargar Street, Tehran, Iran.
Diabetes Res Clin Pract. 2013 Dec;102(3):225-32. doi: 10.1016/j.diabres.2013.10.011. Epub 2013 Oct 9.
To determine the association between glycated hemoglobin (HbA1c) and angiographically proven coronary artery disease (CAD) and its severity in nondiabetic individuals.
We enrolled 299 consecutive individuals undergoing coronary angiography for suspected ischemia. Patients were included if they had no history of prior revascularization or diabetes mellitus and had fasting blood glucose<126mg/dl (7.0mmol/l) and HbA1c<6.5% (47mmol/mol). The severity of the CAD was also evaluated using the Gensini score. Serum HbA1c (NGSP certified Method), highly sensitive C-reactive protein (hsCRP), lipid profile, insulin and APO lipoprotein A1 and B100 levels were measured.
Mean age was 58.8±10.4 year; 60.9% men. One hundred forty seven patients had significant CAD (≥50% stenosis in any major vessel). With increasing HbA1c levels, there was a significant increase in the prevalence of CAD and number of vessels involved. In multivariate analysis, HbA1c emerged as an independent predictor of significant CAD (OR: 2.8, 95% CI: 1.3-6.2, p=0.009). Adjusted ORs for the occurrence of CAD were highest in subjects with both hsCRP and HbA1c in the upper 2 quartiles (OR: 4.183; 95% CI: 1.883-9.290, p<0.0001). There was a significant association between Gensini score and increasing HbA1c tertiles (p=0.038). The ideal cut-off value of HbA1c for prediction of the occurrence of CAD was 5.6% 38mmol/mol) (sensitivity: 60.5%, specificity: 52%).
In non-diabetic subjects, HbA1c could be utilized for risk stratification of CAD and its severity, independent of traditional cardiovascular risk factors, insulin resistance and inflammatory markers.
确定糖化血红蛋白（HbA1c）与经血管造影证实的冠状动脉疾病（CAD）及其在非糖尿病个体中的严重程度之间的关联。
我们连续纳入了299例因疑似缺血而接受冠状动脉造影的个体。如果患者无既往血运重建或糖尿病病史，空腹血糖<126mg/dl（7.0mmol/l）且HbA1c<6.5%（47mmol/mol），则将其纳入研究。还使用Gensini评分评估CAD的严重程度。测量血清HbA1c（NGSP认证方法）、高敏C反应蛋白（hsCRP）、血脂谱、胰岛素以及载脂蛋白A1和B100水平。
平均年龄为58.8±10.4岁；男性占60.9%。147例患者患有显著CAD（任何主要血管狭窄≥50%）。随着HbA1c水平升高，CAD患病率和受累血管数量显著增加。在多变量分析中，HbA1c成为显著CAD的独立预测因子（OR：2.8，95%CI：1.3 - 6.2，p = 0.009）。hsCRP和HbA1c均处于上四分位数的受试者发生CAD的校正OR最高（OR：4.183；%CI：1.883 - 9.290，p<0.0001）。Gensini评分与HbA1c三分位数升高之间存在显著关联（p = 0.038）。预测CAD发生的HbA1c理想截断值为5.6%（38mmol/mol）（敏感性：60.5%，特异性：52%）。
在非糖尿病受试者中，HbA1c可用于CAD及其严重程度的风险分层，独立于传统心血管危险因素、胰岛素抵抗和炎症标志物。
