Kaiser Permanente Medical Center Santa Clara CA.
Kaiser Permanente Division of Research Oakland CA.
J Am Heart Assoc. 2024 May 21;13(10):e033559. doi: 10.1161/JAHA.123.033559. Epub 2024 May 18.
Diabetes is the strongest risk factor for cardiovascular disease, and although glycosylated hemoglobin (HbA1c) levels are known to vary by race, no racial and ethnic-specific diagnostic thresholds exist for diabetes in prediction of cardiovascular disease events. The purpose of this study is to determine whether HbA1c thresholds for predicting major adverse cardiovascular events (MACEs) differ among racial and ethnic groups.
This is a retrospective cohort study of Kaiser Permanente Northern California adult members (n=309 636) with no history of cardiovascular disease who had HbA1c values and race and ethnicity data available between 2014 and 2019. Multivariable logistic regression was used to evaluate the odds of MACEs by the following racial and ethnic groups: Filipino, South Asian, East Asian, Black, White, and Hispanic. A Youden index was used to calculate HbA1c thresholds for MACE prediction by each racial and ethnic group, stratified by sex. Among studied racial and ethnic groups, South Asian race was associated with the greatest odds of MACEs (1.641 [95% CI, 1.456-1.843]; <0.0001). HbA1c was a positive predictor for MACEs, with an odds ratio of 1.024 (95% CI, 1.022-1.025) for each 0.1% increment increase in HbA1c. HbA1c values varied between 6.0% and 7.6% in MACE prediction by race and ethnicity and sex. White individuals, South Asian individuals, East Asian women, and Black men had HbA1c thresholds for MACE prediction in the prediabetic range, between 6.0% and 6.2%. Black women, Hispanic men, and East Asian men had HbA1c thresholds of 6.2% to 6.6%, less than the typical threshold of 7.0% that is used as a treatment goal.
Findings suggest that the use of race and ethnic- and sex-specific HbA1c thresholds may need to be considered in treatment goals and cardiovascular disease risk estimation.
糖尿病是心血管疾病的最强危险因素，尽管糖化血红蛋白（HbA1c）水平因种族而异，但在预测心血管疾病事件方面，尚无针对糖尿病的种族和民族特异性诊断阈值。本研究旨在确定 HbA1c 预测主要不良心血管事件（MACE）的阈值是否因种族和民族群体而异。
这是一项回顾性队列研究，纳入了 Kaiser Permanente 北加利福尼亚州成年成员（n=309636），他们在 2014 年至 2019 年期间有 HbA1c 值和种族及民族数据。多变量逻辑回归用于评估以下种族和民族群体的 MACE 发生几率：菲律宾人、南亚人、东亚人、黑人、白人、西班牙裔。使用约登指数计算每个种族和民族群体的 HbA1c 预测 MACE 的阈值，按性别分层。在所研究的种族和民族群体中，南亚种族与 MACE 发生几率最高（1.641[95%CI，1.456-1.843]；<0.0001）。HbA1c 是 MACE 的阳性预测因子，每增加 0.1%，比值比为 1.024（95%CI，1.022-1.025）。HbA1c 值在种族和民族以及性别的 MACE 预测中在 6.0%至 7.6%之间变化。白人、南亚人、东亚女性和黑人男性的 HbA1c 预测 MACE 的阈值在糖尿病前期范围内，为 6.0%至 6.2%。黑人女性、西班牙裔男性和东亚男性的 HbA1c 阈值为 6.2%至 6.6%，低于作为治疗目标的典型阈值 7.0%。
研究结果表明，在治疗目标和心血管疾病风险评估中可能需要考虑使用种族和民族特异性及性别特异性的 HbA1c 阈值。
