Glycated hemoglobin and long-term prognosis in patients with suspected stable angina pectoris without diabetes mellitus: a prospective cohort study
Eirik Wilberg Rebnord, Eva Ringdal Pedersen, Elin Strand, Gard Frodahl Tveitevåg Svingen, Klaus Meyer, Hall Schartum-Hansen, Kjetil Halvorsen Løland, Reinhard Seifert, Per Magne Ueland, Dennis W T Nilsen, Jan Erik Nordrehaug, Ottar Nygård, Eirik Wilberg Rebnord, Eva Ringdal Pedersen, Elin Strand, Gard Frodahl Tveitevåg Svingen, Klaus Meyer, Hall Schartum-Hansen, Kjetil Halvorsen Løland, Reinhard Seifert, Per Magne Ueland, Dennis W T Nilsen, Jan Erik Nordrehaug, Ottar Nygård
Abstract
Objective: Associations of glycated hemoglobin A1c (HbA1c) levels to incident coronary and cardiovascular events among non-diabetic patients with coronary artery disease are unclear. We investigated relations of HbA1c to long-term prognosis in such patients.
Methods: A prospective cohort of 2519 patients undergoing elective coronary angiography for suspected stable angina pectoris (SAP) was divided into pre-defined categories according to HbA1c (%) levels (<5.0, 5.0-5.6 (reference), 5.7-6.4), and followed for median 4.9 years. The primary end-point was major coronary events (including non-fatal and fatal acute myocardial infarctions, and sudden cardiac death). Secondary end-points were death from cardiovascular disease (CVD) and all-cause mortality. Hazard ratios (HRs) (95% confidence intervals [CIs]) were obtained by Cox regression.
Results: Median age at inclusion was 62 years, 73% were males, median HbA1c was 5.6% and random plasma-glucose 5.4 mmol/L. After multivariate adjustment, HbA1c levels within the pre-diabetic range were not associated with risk of major coronary events, HR (95% CI): 1.13 (0.79-1.62); P=0.49, death from CVD or all-cause mortality HR (95% CI): 0.95 (0.55-1.66) and 1.04 (0.70-1.53), respectively; P≥0.85. Similarly, there was no significant association between HbA1c values within the lowest category and risk of study outcomes, (P≥0.18).
Conclusion: In non-diabetic patients with suspected SAP, there was no overall association between HbA1c levels and prognosis, questioning an independent role of glycemia in the pathogenesis of atherosclerotic complications in these patients.
Trial registration: ClinicalTrials.gov NCT00354081.
Keywords: Coronary artery disease; Glycated; HbA1c; Hemoglobin A; Mortality; Myocardial infarction; Pre-diabetes.
Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.
Source: PubMed