Glycated hemoglobin measurement and prediction of cardiovascular disease.
Creators: name: Emerging Risk Factors Collaboration, 
name: Di Angelantonio, Emanuele
name: Gao, Pei
name: Khan, Hassan
name: Butterworth, Adam
name: Wormser, David
name: Kaptoge, Stephen
name: Kondapally Seshasai, Sreenivasa Rao
name: Thompson, Alex
name: Sarwar, Nadeem
name: Willeit, Peter
name: Ridker, Paul M
name: Barr, Elizabeth LM
name: Khaw, Kay-Tee
name: Psaty, Bruce M
name: Brenner, Hermann
name: Balkau, Beverley
name: Dekker, Jacqueline M
name: Lawlor, Debbie A
name: Daimon, Makoto
name: Willeit, Johann
name: Njølstad, Inger
name: Nissinen, Aulikki
name: Brunner, Eric J
name: Kuller, Lewis H
name: Price, Jackie F
name: Sundström, Johan
name: Knuiman, Matthew W
name: Feskens, Edith JM
name: Verschuren, WMM
name: Wald, Nicholas
name: Bakker, Stephan JL
name: Whincup, Peter H
name: Ford, Ian
name: Goldbourt, Uri
name: Gómez-De-La-Cámara, Agustín
name: Gallacher, John
name: Simons, Leon A
name: Rosengren, Annika
name: Sutherland, Susan E
name: Björkelund, Cecilia
name: Blazer, Dan G
name: Wassertheil-Smoller, Sylvia
name: Onat, Altan
name: Marín Ibañez, Alejandro
name: Casiglia, Edoardo
name: Jukema, J Wouter
name: Simpson, Lara M
name: Giampaoli, Simona
name: Nordestgaard, Børge G
name: Selmer, Randi
name: Wennberg, Patrik
name: Kauhanen, Jussi
name: Salonen, Jukka T
name: Dankner, Rachel
name: Barrett-Connor, Elizabeth
name: Kavousi, Maryam
name: Gudnason, Vilmundur
name: Evans, Denis
name: Wallace, Robert B
name: Cushman, Mary
name: D'Agostino, Ralph B
name: Umans, Jason G
name: Kiyohara, Yutaka
name: Nakagawa, Hidaeki
name: Sato, Shinichi
name: Gillum, Richard F
name: Folsom, Aaron R
name: Van Der Schouw, Yvonne T
name: Moons, Karel G
name: Griffin, Simon
name: Sattar, Naveed
name: Wareham, Nicholas
name: Selvin, Elizabeth
name: Thompson, Simon
name: Danesh, John
Publisher: name: Apollo - University of Cambridge Repository
Year: 2014
Subjects: Emerging Risk Factors Collaboration
Humans
Coronary Disease
Diabetes Mellitus
C-Reactive Protein
Risk Assessment
Prospective Studies
Predictive Value of Tests
Aged
Middle Aged
Female
Male
Cholesterol, HDL
Stroke
Glycated Hemoglobin A

description: IMPORTANCE: The value of measuring levels of glycated hemoglobin (HbA1c) for the prediction of first cardiovascular events is uncertain. OBJECTIVE: To determine whether adding information on HbA1c values to conventional cardiovascular risk factors is associated with improvement in prediction of cardiovascular disease (CVD) risk. DESIGN, SETTING, AND PARTICIPANTS: Analysis of individual-participant data available from 73 prospective studies involving 294,998 participants without a known history of diabetes mellitus or CVD at the baseline assessment. MAIN OUTCOMES AND MEASURES: Measures of risk discrimination for CVD outcomes (eg, C-index) and reclassification (eg, net reclassification improvement) of participants across predicted 10-year risk categories of low (&lt;5%), intermediate (5% to &lt;7.5%), and high (≥ 7.5%) risk. RESULTS: During a median follow-up of 9.9 (interquartile range, 7.6-13.2) years, 20,840 incident fatal and nonfatal CVD outcomes (13,237 coronary heart disease and 7603 stroke outcomes) were recorded. In analyses adjusted for several conventional cardiovascular risk factors, there was an approximately J-shaped association between HbA1c values and CVD risk. The association between HbA1c values and CVD risk changed only slightly after adjustment for total cholesterol and triglyceride concentrations or estimated glomerular filtration rate, but this association attenuated somewhat after adjustment for concentrations of high-density lipoprotein cholesterol and C-reactive protein. The C-index for a CVD risk prediction model containing conventional cardiovascular risk factors alone was 0.7434 (95% CI, 0.7350 to 0.7517). The addition of information on HbA1c was associated with a C-index change of 0.0018 (0.0003 to 0.0033) and a net reclassification improvement of 0.42 (-0.63 to 1.48) for the categories of predicted 10-year CVD risk. The improvement provided by HbA1c assessment in prediction of CVD risk was equal to or better than estimated improvements for measurement of fasting, random, or postload plasma glucose levels. CONCLUSIONS AND RELEVANCE: In a study of individuals without known CVD or diabetes, additional assessment of HbA1c values in the context of CVD risk assessment provided little incremental benefit for prediction of CVD risk.