Better risk assessment with glycated hemoglobin instead of cholesterol in CVD risk prediction charts

Faeh, David; Rohrmann, Sabine; Braun, Julia

doi:10.1007/s10654-013-9827-6

Cited by 8 publications

(4 citation statements)

References 11 publications

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“…This includes elevation of glucose and HbA 1c in the normal range in addition to the elevation that occurs in diabetes 60, 61, 63, 64, 65. Further, observations in the general population have shown that HbA 1c and blood glucose are better markers of cardiovascular and CHD risk than either HDL cholesterol or total cholesterol66, 67 (see also Experimental section).…”

Section: Discussionmentioning

confidence: 94%

Coronary Heart Disease and Dietary Carbohydrate, Glycemic Index, and Glycemic Load: Dose-Response Meta-analyses of Prospective Cohort Studies

Livesey

2019

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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ObjectiveTo clarify the role of dietary carbohydrate, glycemic index (GI), and glycemic load (GL) in progression from health to coronary heart disease (CHD) by determining disease-nutrient risk relation (RR) values needed for intake ranges within jurisdictions and across the globe.MethodsWe performed a literature search of MEDLINE and EMBASE for prospective cohort studies that used truly valid dietary instruments in heathy adults published from January 1, 2000, to June 5, 2018. Relevant observations were extracted by 2 reviewers independently. We used dose-response meta-analysis accounting for nonindependence of results within studies. Bradford-Hill criteria were used to assess causality.ResultsEligible studies had a mean follow-up of 11 years (range, 5-19 years), were conducted in North America, Europe, and East Asia, and yielded combined RRs of 1.44 (95% CI, 1.25-1.65) per 65 g/d GL (11 studies) and 1.24 (95% CI, 1.12-1.38) per 10 U GI (10 studies) (glucose scale). The CHD-carbohydrate RR on GI was 1.66 (95% CI, 1.23-2.25) per 98 g/d of carbohydrates per 10 units GI. The 65 g/d GL, 10 U GI, and 98 g/d carbohydrate values corresponded to oral intakes from the 10th to the 90th percentiles within sampled populations. Inconsistencies were minor (I2≤20%), as were small-study effects (P=.61 for GL and P=.26 for GI). Funnel plots were symmetric. Cubic spline dose-response meta-analysis yielded RRs as follows: across the global range for GL (55-290 g/d), 5.5 (95% CI, 3.1-9.8) (I2=0); for GI (47-82 U), 2.71 (95% CI, 1.47-4.40) (I2=0); and for the CHD-carbohydrate dependence on GI (50-80 U), 4.57 (95% CI, 1.86-11.4) (I2=16%). Bradford-Hill criteria indicated that these relations were probably causal.ConclusionStrong and probably causal CHD-GL and GI RRs exist within populations. The RRs were remarkably higher across global exposures. The results support the consideration of these markers of carbohydrate food quality in dietary guidelines for general populations.Trial RegistrationPROSPERO Identifier: CRD42013004504

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Section: Discussionmentioning

confidence: 94%

Coronary Heart Disease and Dietary Carbohydrate, Glycemic Index, and Glycemic Load: Dose-Response Meta-analyses of Prospective Cohort Studies

Livesey

2019

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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“…The threshold value of 48 mmol/mol (6.5%) is now recognised as the cut‐off point for T2DM; therefore, from our data five of the individuals would have undiagnosed diabetes and these health assessments justify an initiative (workplace or otherwise) of screening for diabetes. In addition, HbA 1c values are have been shown to be an independent risk factor for CHD and have also been proven to be better at predicting cardiovascular risk than total cholesterol in some risk prediction models …”

Section: Discussionmentioning

confidence: 99%

“…In addition, HbA1c values are have been shown to be an independent risk factor for CHD 24 and have also been proven to be better at predicting cardiovascular risk than total cholesterol in some risk prediction models. 25 Age stratification revealed a number of changes in baseline variables and predicted risk. The changes in total cholesterol concentrations in the older age groups are consistent with previous studies.…”

Section: Risk Variable Lhb Employees (N=371)mentioning

confidence: 99%

Prevalence of metabolic risk factors and associated 10-year prediction of cardiovascular disease and diabetes in female employees

et al. 2014

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Cardiovascular disease (CVD) and type 2 diabetes (T2DM) remain two of the greatest health challenges in the United Kingdom. Guidelines currently advocate screening individuals to identify those at 'high risk' (10-year risk ≥20%) of CVD and T2DM. This study examined the prevalence of undiagnosed risk factors associated with these two conditions and predicted 10-year risk.Female local health board employees (n=371) with no prior diagnosis of CVD or T2DM accepted an invitation for a workplace-based health assessment. Demographic, anthropometric, systolic and diastolic blood pressure, family and medical histories were all recorded and capillary blood samples obtained for analysis of total and HDL cholesterol and HbA1c. Ten-year CVD and T2DM risk were predicted using the QRISK2 and QDiabetes algorithms, respectively.A significant proportion of females were either overweight (37.2%) or obese (23.5%), coupled with a high percentage with central obesity (77.6%). Systolic hypertension (42.0%), diastolic hypertension (39.4%) and/or reduced HDL concentrations (32.6%) were also prevalent in a large number of female workers. However, <1% of all workers were at 'high risk' of CVD and only 3.2% were predicted to be at 'high risk' of developing T2DM in the next 10 years. The vast majority of females assessed were at 'low risk' (<10%) of either CVD or T2DM.Despite strong evidence of metabolic risk factors observed in female employees, only a small proportion of workers were predicted to be at 10-year high risk of either CVD or T2DM. ≥80mmHg) improved by 16mmHg and 11mmHg in systolic and diastolic levels respectively, following the intervention. 11 The aim of this study was to investigate the prevalence of isolated risk factors that contribute to both CVD and T2DM and predicted risk of these two conditions in female employees of a local health board in Carmarthenshire, South Wales, UK. This region has a high prevalence of T2DM and CVD, with latest statistics documenting that, in 2010, death rates per 100 000 individuals were 196.69 and 91.80 from all forms of CVD and coronary heart disease (CHD), respectively. 14 Methods Study population. All participants in this study were female employees of the local health board (LHB; Hywel Dda Health Board) within the Welsh region of Carmarthenshire. This worksite was part of an established project entitled 'Prosiect Sir Gâr' (PSG; the 'Carmarthenshire Project' 15 ). All current employees over the age of 40 years if Caucasian, or 25 years if South Asian, with no prior diagnosis of CVD or diabetes were invited to participate in the project. Individuals with a previous cardiovascular event, established diabetes or a family history of hypercholesterolaemia were excluded from the programme. In total, 371 female LHB employees accepted the invitation for a cardiovascular and diabetes baseline assessment. All participants provided written consent and this study was approved by Dyfed Powys Local Research Ethics Committee (reference number: 11/WA/0101).Baseline measurements and risk prediction...

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“…However, HbA1c may be a better predictor of CVD and all-cause mortality than PG, also because it can be measured and interpreted independently of fasting state (Faeh et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

J-shaped association between plasma glucose concentration and cardiovascular disease mortality over a follow-up of 32years

Gunten

Braun

Bopp

et al. 2013

Preventive Medicine

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OBJECTIVE: We aimed at examining the association between plasma glucose (PG) concentration and cardiovascular mortality in a population sample from Switzerland over a follow-up time of 32 years. METHODS: We analyzed 7984 men and women enrolled in the first National Research Program (NRP1A, 1977-1979 and followed up for survival until 2008. Mortality hazard ratios (HR) were calculated using adjusted Cox regression models. PG was measured in fasting state or randomly with known fasting time. Models were adjusted for age, sex, socio-demographic, lifestyle and cardiovascular risk factors. RESULTS: PG concentrations 6.1mmol/L were associated with increased risk of cardiovascular disease (CVD) and all-cause mortality. Compared to normal PG (3.8-4.9mmol/L) the adjusted HR (95% CI) for CVD mortality was 1.26 (1.01-1.58) for PG 6.1-6.9mmol/L, 1.56 (1.18-2.06) for PG 7mmol/L, 1.67 (1.22-2.30) for known diabetes. All-cause mortality essentially showed the same patterns. All-cause mortality was increased [HR (95% CI): 1.35 (1.01-1.80)] also for PG <3.8mmol/L. CONCLU-SION: Plasma glucose remained significantly and independently associated with CVD mortality even after full follow-up. The relationship was J-shaped. In order to prevent premature death, persons with abnormal PG concentrations on both extremes should be screened and counseled for other CVD risk factors. Methods:We analyzed 7,984 men and women enrolled in the first National Research Program (NRP1A, 1977-1979 and followed up for survival until 2008. Mortality hazard ratios (HR) were calculated using adjusted Cox regression models. PG was measured in fasting state or randomly with known fasting time. Models were adjusted for age, sex, sociodemographic, lifestyle and cardiovascular risk factors.Results: PG concentrations ≥6.1 mmol/L were associated with increased risk of cardiovascular disease (CVD) and all-cause mortality. Compared to normal PG (3.8-4.9 mmol/L) the adjusted HR (95% CI) for CVD mortality was 1.26 (1.01-1.58) for PG ≥6.1-6.9 mmol/L, 1.56 (1.18-2.06) for PG ≥7 mmol/L, 1.67 (1.22-2.30) for known diabetes. All-cause mortality essentially showed the same patterns. All-cause mortality was increased [HR (95% CI): 1.35 (1.01-1.80)] also for PG <3.8 mmol/L. Conclusion:Plasma glucose remained significantly and independently associated with CVD mortality even after full follow-up. The relationship was J-shaped. In order to prevent premature death, persons with abnormal PG concentrations on both extremes should be screened and counselled for other CVD risk factors.

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Better risk assessment with glycated hemoglobin instead of cholesterol in CVD risk prediction charts

Cited by 8 publications

References 11 publications

Coronary Heart Disease and Dietary Carbohydrate, Glycemic Index, and Glycemic Load: Dose-Response Meta-analyses of Prospective Cohort Studies

Coronary Heart Disease and Dietary Carbohydrate, Glycemic Index, and Glycemic Load: Dose-Response Meta-analyses of Prospective Cohort Studies

Prevalence of metabolic risk factors and associated 10-year prediction of cardiovascular disease and diabetes in female employees

J-shaped association between plasma glucose concentration and cardiovascular disease mortality over a follow-up of 32years

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