HbA1c is an independent predictor of non-fatal cardiovascular disease in a Caucasian population without diabetes: a 10-year follow-up of the Hoorn Study

Abstract

Aims: To investigate the associations of HbA1c, fasting glucose, and postload plasma glucose with 10-year fatal and non-fatal cardiovascular disease (CVD) and all-cause mortality in Caucasian individuals between 50 and 75 years of age without diabetes.

Method and results: The 10-year risk of all-cause mortality and CVD in relation to HbA1cand glucose levels was assessed with Cox survival analysis in 1674 non-diabetic individuals of a population-based cohort (Hoorn Study). Analyses were stratified according to sex and adjustments were made for age and known CVD risk factors. After full adjustment, HbA1c levels ≥ 6.0% were significantly associated with an increased risk of non-fatal CVD compared with the lowest category of HbA1c (≤ 5.1%) in women [hazards ratio (HR) 2.27 (1.24-4.14)]. In addition, HbA1c as a continuous variable was significantly related to non-fatal CVD in both men [HR 1.40 (1.01-1.95)] and women [HR 2.41 (1.51-3.83)]. The relationships of HbA1 c with fatal CVD and all-cause mortality were explained by traditional CVD risk factors in both the sexes, along with the associations between fasting or postload plasma glucose and any of the outcome measures.

Conclusion: In Caucasian men and especially in women between 50 and 75 years of age who are without diabetes, high HbA1c levels are associated with increased risk of future non-fatal CVD, independent of other CVD risk factors.