Fructosamine and Glycated Albumin and the Risk of Cardiovascular Outcomes and Death

Abstract

Background HbA1c is the standard measure to monitor glucose control in diabetes and is a marker of future cardiovascular risk. Fructosamine and glycated albumin are markers of short-term glycemic control but their associations with cardiovascular outcomes are uncharacterized. Methods and Results We measured glycated albumin and fructosamine in 11,104 participants with and without diabetes in the community-based Atherosclerosis Risk in Communities (ARIC) Study in 1990–1992 (baseline). We evaluated associations of fructosamine and glycated albumin with risk of coronary heart disease, ischemic stroke, heart failure and mortality. We compared associations to those observed for HbA1c. During two decades of follow-up there were 1096 new cases of coronary heart disease, 605 of ischemic stroke, 1432 of heart failure, and 2860 deaths. Elevated baseline concentrations of fructosamine and glycated albumin were significantly associated with each of the outcomes even after adjustment for traditional cardiovascular risk factors, with especially strong associations in persons with diabetes. Associations were of similar magnitude to those observed for HbA1c and—as has been previously observed for HbA1c—the associations tended to be J-shaped, with an elevation of risk at the lowest levels of each biomarker. Conclusions The acceptance of new measures of hyperglycemia is partly dependent on establishing their association with long-term outcomes. We found that fructosamine and glycated albumin were associated with vascular outcomes and mortality and that these associations were similar to those observed for HbA1c.

Antisense-Mediated Lowering of Plasma Apolipoprotein C-III by Volanesorsen Improves Dyslipidemia and Insulin Sensitivity in Type 2 Diabetes

“…Recent evidence indicates that, like HbA 1c , the medium-term markers also associate with cardiovascular risk (30,31). The reduction in HbA 1c , which reached statistical significance versus placebo 3 months after cessation of treatment, likely reflects the long drug elimination half-life of ;4 weeks (Supplementary Table 4) and subsequent prolonged duration of action.…”

Metrics Beyond Hemoglobin A1C in Diabetes Management: Time in Range, Hypoglycemia, and Other Parameters

“…12 Glycated proteins have been associated with micro- [13][14][15] and macrovascular complications [16][17][18][19][20][21] and mortality in people with DM. 22 Several prospective studies have shown their utility for patients at risk of developing micro-and macrovascular complications. 13,23,24 FA and GA are extracellular proteins that provide an index of average glucose over a period of 2-3 weeks, their average half-life, thus proposed as intermediate markers of glucose control.…”

Racial Differences in and Prognostic Value of Biomarkers of Hyperglycemia

“…Higher levels of biomarkers of hyperglycemia have been associated with increased risk of microvascular and macrovascular complications in both people with and people without diabetes (11–17). However, prospective associations of nontraditional serum biomarkers of hyperglycemia with microvascular and macrovascular complications according to race have not been characterized and could shed further light on the debate over racial differences in HbA 1c .…”