Visit-to-Visit Variability of Hemoglobin A1c in People Without Diabetes and Risk of Major Adverse Cardiovascular Events and All-Cause Mortality

• DOI: 10.2337/dc18-1396
• Publication Date: 2018-10-23T17:50:08Z
• Authors: Jonas Ghouse; Morten W. Skov; Jørgen K. Kanters; Bent Lind; Jonas L. Isaksen; Paul Blanche; Stig Haunsø; Lars Køber; Jesper H. Svendsen; Morten S. Olesen; Anders G. Holst; Thomas A. Gerds; Jonas B. Nielsen
• Keywords: Blood Glucose; Glycated Hemoglobin; Male; Blood Glucose/metabolism; Incidence; Cardiovascular Diseases/blood; Comorbidity; Middle Aged; Sensitivity and Specificity; Glycated Hemoglobin A/analysis; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Diabetes Mellitus, Type 2; Cardiovascular Diseases; Risk Factors; Humans; Female; Mortality; Aged; Follow-Up Studies; Proportional Hazards Models

We aimed to study whether visit-to-visit variability of glycated hemoglobin A1c (HbA1c) is associated with incident major adverse cardiovascular events (MACE), all-cause mortality, and type 2 diabetes in people without diabetes.We included primary care patients no history or disease three annual HbA1c measurements within normal range (<6.5% [48 mmol/mol]). For each individual, we measured the as SD residuals obtained from a linear regression on measurements. From regression, also estimated index (intercept) trend over time (slope). Follow-up began at date third measurement. Associations between outcome were analyzed using Cox adjusted for traditional risk factors, intercept, reported hazard ratio per increase (HRSD).In total, 6,756 individuals included. During median follow-up 6.3 years, 996 developed MACE, 856 died, 1,267 diabetes. found significant association increasing MACE (HRSD 1.09 [95% CI 1.03-1.15]) mortality 1.13 1.07-1.20]), whereas there associations 1.00 0.95-1.05]). calculated 5-year absolute risks clinically relevant differences across several age, sex, comorbidity, variability-defined subgroups.In population free disease, high was increased mortality.