Glycosylated hemoglobin and the risk of death and cardiovascular mortality in the elderly

Chonchol, M.; Katz, R.; Fried, L.F.; Sarnak, M.J.; Siscovick, D.S.; Newman, A.B.; Strotmeyer, E.S.; Bertoni, A.; Shlipak, M.G.

doi:10.1016/j.numecd.2009.02.007

« Previous Next »Nutrition, Metabolism & Cardiovascular Diseases
Volume 20, Issue 1 , Pages 15-21, January 2010

Glycosylated hemoglobin and the risk of death and cardiovascular mortality in the elderly

M. Chonchol
- University of Colorado Health Sciences Center, Division of Renal Diseases and Hypertension, Box C-280, Denver, CO 80262, USA
- Corresponding author. Tel.: +1 303 399 6997; fax: +1 303 399 3131.
R. Katz
- Collaborative Health Studies Coordinating Center, University of Washington, Seattle, WA, USA
L.F. Fried
- Veterans Affairs Pittsburgh Healthcare System, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA, USA
M.J. Sarnak
- Department of Medicine, Tufts Medical Center, Boston, MA, USA
D.S. Siscovick
- University of Washington, Departments of Medicine and Epidemiology, Cardiovascular Health Research Unit, Seattle, WA, USA
A.B. Newman
- University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA, USA
E.S. Strotmeyer
- University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA, USA
A. Bertoni
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
M.G. Shlipak
- University of California San Francisco, General Internal Medicine Section, Veterans Affairs Medical Center, University of California, San Francisco, CA, USA

Received 8 October 2008; received in revised form 6 February 2009; accepted 17 February 2009. published online 13 April 2009.

Abstract

Background and aims

Glycosylated hemoglobin (HbA_1c) has been associated with incident cardiovascular disease (CVD), but the findings are inconsistent. We tested the hypothesis that HbA_1c may be associated with an increased risk of death and cardiovascular mortality in older adults.

Methods and results

We evaluated the association between HbA_1c with all-cause and cardiovascular mortality in 810 participants without a history of diabetes in a sub-study of the Cardiovascular Health Study (CHS), a community cohort study of individuals ≥65years of age. Glycosylated hemoglobin was measured at baseline and all-cause and cardiovascular mortality was assessed during the follow-up period. The relation between baseline HbA_1c and death was evaluated with multivariate Cox proportional hazards regression models. After a median follow-up of 14.2years, 416 deaths were observed. The crude incidence rates of all-cause mortality across HbA_1c groups were: 4.4% per year, 4.3% per year and 4.6% per year for tertile 1 (≤5.6%), tertile 2 (5.61–6.20%) and tertile 3 (≥6.21%), respectively. In unadjusted and fully adjusted analyses, baseline HbA_1c was not associated with all-cause mortality and cardiovascular mortality (hazard ratio: 1.16 [95% confidence interval 0.91–1.47] and hazard ratio: 1.31 [95% confidence interval 0.90–1.93], respectively for the highest HbA_1c tertile compared with the lowest).

Conclusion

These results suggest that HbA_1c does not significantly predict all-cause and cardiovascular mortality in non-diabetic community-dwelling older adults.

Keywords: Glycosylated hemoglobin, Hemoglobin A1c, Cardiovascular disease, Mortality, Elderly