Department of Cardiology, University Heart & Vascular Center Hamburg, Martinistr. 52, 20246, Hamburg, Germany.
German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
Cardiovasc Diabetol. 2021 Nov 15;20(1):223. doi: 10.1186/s12933-021-01413-4.
BACKGROUND: Biomarkers may contribute to improved cardiovascular risk estimation. Glycated hemoglobin A (HbA) is used to monitor the quality of diabetes treatment. Its strength of association with cardiovascular outcomes in the general population remains uncertain. This study aims to assess the association of HbA with cardiovascular outcomes in the general population. METHODS: Data from six prospective population-based cohort studies across Europe comprising 36,180 participants were analyzed. HbA was evaluated in conjunction with classical cardiovascular risk factors (CVRFs) for association with cardiovascular mortality, cardiovascular disease (CVD) incidence, and overall mortality in subjects without diabetes (N = 32,496) and with diabetes (N = 3684). RESULTS: Kaplan-Meier curves showed higher event rates with increasing HbA levels (log-rank-test: p < 0.001). Cox regression analysis revealed significant associations between HbA (in mmol/mol) in the total study population and the examined outcomes. Thus, a hazard ratio (HR) of 1.16 (95% confidence interval (CI) 1.02-1.31, p = 0.02) for cardiovascular mortality, 1.13 (95% CI 1.03-1.24, p = 0.01) for CVD incidence, and 1.09 (95% CI 1.02-1.17, p = 0.01) for overall mortality was observed per 10 mmol/mol increase in HbA. The association with CVD incidence and overall mortality was also observed in study participants without diabetes with increased HbA levels (HR 1.12; 95% CI 1.01-1.25, p = 0.04) and HR 1.10; 95% CI 1.01-1.20, p = 0.02) respectively. HbA cut-off values of 39.9 mmol/mol (5.8%), 36.6 mmol/mol (5.5%), and 38.8 mmol/mol (5.7%) for cardiovascular mortality, CVD incidence, and overall mortality, showed also an increased risk. CONCLUSIONS: HbA is independently associated with cardiovascular mortality, overall mortality and cardiovascular disease in the general European population. A mostly monotonically increasing relationship was observed between HbA levels and outcomes. Elevated HbA levels were associated with cardiovascular disease incidence and overall mortality in participants without diabetes underlining the importance of HbA levels in the overall population.
背景：生物标志物可能有助于改善心血管风险评估。糖化血红蛋白 A（HbA）用于监测糖尿病治疗质量。其与普通人群心血管结局的关联强度仍不确定。本研究旨在评估 HbA 与普通人群心血管结局的关系。
方法：分析了来自欧洲六个前瞻性人群为基础的队列研究的数据，共纳入 36180 名参与者。评估了 HbA 与经典心血管危险因素（CVRFs）的关联，以评估无糖尿病（N=32496）和糖尿病（N=3684）患者的心血管死亡率、心血管疾病（CVD）发病率和总死亡率。
结果：Kaplan-Meier 曲线显示，随着 HbA 水平的升高，事件发生率更高（对数秩检验：p<0.001）。Cox 回归分析显示，HbA（以 mmol/mol 表示）与总研究人群的研究结果之间存在显著关联。因此，心血管死亡率的风险比（HR）为 1.16（95%置信区间（CI）1.02-1.31，p=0.02），CVD 发病率的 HR 为 1.13（95%CI 1.03-1.24，p=0.01），总死亡率的 HR 为 1.09（95%CI 1.02-1.17，p=0.01），每增加 10 mmol/mol HbA 就会观察到。在 HbA 水平升高的无糖尿病患者中也观察到与 CVD 发病率和总死亡率的关联（HR 1.12；95%CI 1.01-1.25，p=0.04）和 HR 1.10；95%CI 1.01-1.20，p=0.02）。心血管死亡率、CVD 发病率和总死亡率的 HbA 截断值分别为 39.9 mmol/mol（5.8%）、36.6 mmol/mol（5.5%）和 38.8 mmol/mol（5.7%），也显示出风险增加。
结论：HbA 与普通欧洲人群的心血管死亡率、总死亡率和心血管疾病独立相关。HbA 水平与结局之间观察到的关系主要是单调递增的。HbA 水平升高与无糖尿病患者的心血管疾病发病率和总死亡率相关，这强调了 HbA 水平在总体人群中的重要性。
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