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

BMC Nephrology

Ricardo Gomez-Huelgas¹  Armando Torres⁴  Pedro Ruiz-Esteban⁶  Ana M Armas-Padron⁷  Francisco J Tinahones⁵  Antonio J Baca-Osorio²  Jose Mancera-Romero²  M Rosa Bernal-Lopez¹  Ana Espejo-Gil³  Domingo Hernandez⁶ 

[1] Ciber Fisiopatologia de la Obesidad y Nutricion, Instituto de Salud Carlos III, Madrid, Spain;Health Care “Ciudad Jardin”, Malaga, Spain;Internal Medicine Department, Hospital Regional Universitario Carlos Haya, Avenida Carlos Haya s/n, 29010 Malaga, Spain;Research Unit, Hospital Universitario de Canarias, Tenerife, Spain;Endocrinology Department, Hospital Virgen de la Victoria, Malaga, Spain;Nephrology Department, Hospital Regional Universitario Carlos Haya, Malaga, Spain;Health Care “La Cuesta”, Tenerife, Spain

关键词: Cardiovascular disease;    Chronic kidney disease;    Glycated hemoglobin;   

Others  :  1082888
DOI  :  10.1186/1471-2369-14-151

 received in 2013-02-12, accepted in 2013-07-11,  发布年份 2013

【 摘 要 】

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.

【 授权许可】

   
2013 Hernandez et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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