非糖尿病成人のHbA1c値、
空腹時血糖値に比べ心血管疾患リスクと強く相関
文献：Selvin E et al. Glycated Hemoglobin, Diabetes, and Cardiovascular Risk in Nondiabetic Adults. NEJM. 2010;362:800-811
非糖尿病成人11092名を対象に、HbA1c値の糖尿病・心血管疾患リスク予測能を空腹時血糖値と比較。HbA1c値は空腹時血糖値に比べて、糖尿病リスクとは同程度、心血管疾患・全死因死亡リスクとはより強い相関を示した。著者らは、この結果をHbA1c値による糖尿病診断をさらに支持するエビデンスと位置づけている。
Glycated Hemoglobin, Diabetes, and Cardiovascular Risk in Nondiabetic Adults
Elizabeth Selvin, Ph.D., M.P.H., Michael W. Steffes, M.D., Ph.D., Hong Zhu, B.S., Kunihiro Matsushita, M.D., Ph.D., Lynne Wagenknecht, Dr.P.H., James Pankow, Ph.D., M.P.H., Josef Coresh, M.D., Ph.D., and Frederick L. Brancati, M.D., M.H.S.
ABSTRACT
Background Fasting glucose is the standard measure used to diagnose diabetes in the United States. Recently, glycated hemoglobin was also recommended for this purpose.
Methods We compared the prognostic value of glycated hemoglobin and fasting glucose for identifying adults at risk for diabetes or cardiovascular disease. We measured glycated hemoglobin in whole-blood samples from 11,092 black or white adults who did not have a history of diabetes or cardiovascular disease and who attended the second visit (occurring in the 1990-1992 period) of the Atherosclerosis Risk in Communities (ARIC) study.
Results The glycated hemoglobin value at baseline was associated with newly diagnosed diabetes and cardiovascular outcomes. For glycated hemoglobin values of less than 5.0%, 5.0 to less than 5.5%, 5.5 to less than 6.0%, 6.0 to less than 6.5%, and 6.5% or greater, the multivariable-adjusted hazard ratios (with 95% confidence intervals) for diagnosed diabetes were 0.52 (0.40 to 0.69), 1.00 (reference), 1.86 (1.67 to 2.08), 4.48 (3.92 to 5.13), and 16.47 (14.22 to 19.08), respectively. For coronary heart disease, the hazard ratios were 0.96 (0.74 to 1.24), 1.00 (reference), 1.23 (1.07 to 1.41), 1.78 (1.48 to 2.15), and 1.95 (1.53 to 2.48), respectively.
The hazard ratios for stroke were similar. In contrast, glycated hemoglobin and death from any cause were found to have a J-shaped association curve. All these associations remained significant after adjustment for the baseline fasting glucose level. The association between the fasting glucose levels and the risk of cardiovascular disease or death from any cause was not significant in models with adjustment for all covariates as well as glycated hemoglobin. For coronary heart disease, measures of risk discrimination showed significant improvement when glycated hemoglobin was added to models including fasting glucose.
Conclusions In this community-based population of nondiabetic adults, glycated hemoglobin was similarly associated with a risk of diabetes and more strongly associated with risks of cardiovascular disease and death from any cause as compared with fasting glucose. These data add to the evidence supporting the use of glycated hemoglobin as a diagnostic test for diabetes.
Source Information
From the Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research (E.S., K.M., J.C., F.L.B.), and the Department of Biostatistics (H.Z., J.C.), Johns Hopkins Bloomberg School of Public Health; and the Division of General Internal Medicine, Department of Medicine, Johns Hopkins University (E.S., J.C., F.L.B.) all in Baltimore; the Department of Laboratory Medicine and Pathology, Medical School (M.W.S.), and the Division of Epidemiology and Community Health (J.P.), University of Minnesota, Minneapolis; and the Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (L.W.).
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