Association of HbA1c and cardiovascular and renal disease in an adult Mediterranean population

作者：Hernandez Domingo; Espejo Gil Ana; Rosa Bernal Lopez M; Mancera Romero Jose; Baca Osorio Antonio J; Tinahones Francisco J; Armas Padron Ana M; Ruiz Esteban Pedro; Torres Armando; Gomez Huelgas Ricardo

来源：BMC Nephrology, 2013, 14(1): 151.

DOI：10.1186/1471-2369-14-151

• Glycated hemoglobin
• Chronic kidney disease
• Cardiovascular disease

Background: Increasing evidence suggests a mechanistic link between the glycemic environment and renal and cardiovascular events, even below the threshold for diabetes. We aimed to assess the association between HbA1c and chronic kidney disease (CKD) and cardiovascular disease (CVD).
Methods: A cross-sectional study involving a random representative sample of 2270 adults from southern Spain (Malaga) was undertaken. We measured HbA1c, serum creatinine and albuminuria in fasting blood and urine samples.
Results: Individuals without diabetes in the upper HbA1c tertile had an unfavorable cardiovascular and renal profile and shared certain clinical characteristics with the patients with diabetes. Overall, a higher HbA1c concentration was strongly associated with CKD or CVD after adjustment for traditional risk factors. The patients with known diabetes had a 2-fold higher odds of CKD or CVD. However, when both parameters were introduced in the same model, the HbA1c concentration was only significantly associated with clinical endpoints (OR: 1.4, 95% CI, 1.1-1.6, P = 0.002). An increase in HbA1c of one percentage point was associated with a 30% to 40% increase in the rate of CKD or CVD. This relationship was apparent in persons with and without known diabetes. ROC curves illustrated that a HbA1c of 37 mmol/mol (5.5%) was the optimal value in terms of sensitivity and specificity for predicting endpoints in this population.
Conclusion: HbA1c levels were associated with a higher prevalence of CKD and CVD cross-sectionally, regardless of diabetes status. These data support the value of HbA1c as a marker of cardiovascular and renal disease in the general population.

• 出版日期2013-7-17