Hemoglobin A1c Is Positively Correlated with Framingham Risk Score in Older, Apparently Healthy Nondiabetic Korean Adults

Abstract

BackgroundSeveral studies have suggested that elevated levels of hemoglobin A1c (HbA1c) are associated with cardiovascular disease (CVD) in nondiabetic individuals. However, it is unclear whether HbA1c levels can serve as a simple screening marker for increased CVD risk in nondiabetic individuals. Our objective was to evaluate the relationship between HbA1c levels and CVD risk using the Framingham risk score (FRS) in older, apparently healthy nondiabetic Korean adults.MethodsWe retrospectively studied 2,879 Korean adults between the ages of 40 and 79 who underwent voluntary health check-ups at the Health Promotion Center of our hospital from July 2009 to June 2011. Subjects were subdivided based on their HbA1c levels into four groups: tertiles within the HbA1c normal tolerance range and a group for subjects with an increased risk for diabetes (IRD).ResultsThe mean FRS for the upper tertile (9.6±3.8) group was significantly higher than that of the middle tertile (8.4±4.0) and lower tertile (7.6±3.8) groups. In addition, FRS was highest in the IRD group (10.5±3.7). Multiple linear regression analysis demonstrated that HbA1c levels exhibited a significant positive correlation with FRS when adjusted for confounding variables in all subjects (β±standard error [SE], 0.018±0.002; R2, 0.131), women (β±SE, 0.023±0.003; R2, 0.170), and men (β±SE, 0.016±0.004; R2, 0.109).ConclusionHbA1c levels were positively correlated with FRS in older, apparently healthy nondiabetic Korean adults. We propose that HbA1c levels may reflect CVD risk in nondiabetic individuals.

Framingham Risk Score Assessment in Subjects with Pre-diabetes and Diabetes: A Cross-Sectional Study in Korea

“… 34 A retrospective study of 2,879 Korean adults aged 40 to 79 years without diabetes revealed that HbA1c levels were positively correlated with the FRS and may reflect CVD risk in subjects without diabetes. 35 In the present study, we demonstrated that an increase in HbA1c was associated with an increase in the FRS, indicating a higher probability of CV complications in subjects with uncontrolled diabetes. In subjects with high CV risk, the FRS was higher when HbA1c was ≥7%, alcohol was consumed, and LVH was present.…”

Brief Review of Articles in 'Endocrinology and Metabolism' in 2013

“…In 2013, there were two interesting original articles about the association between hemoglobin A1c and cardiovascular disease: "Hemoglobin A1c is positively correlated with Framingham risk score in older, apparently healthy nondiabetic Korean adults" [ 23 ] and "A1c variability can predict coronary artery disease in patients with type 2 diabetes with mean A1c levels greater than 7" [ 24 ]. The relationship between vitamin D status, obesity, and insulin resistance was investigated by Kang et al [ 25 ] using data from 2,710 individuals aged ≥50 years based on national data from a representative sample of Korea National Health and Nutrition Examination Survey IV-2 in 2008.…”

Physician-Directed Diabetes Education without a Medication Change and Associated Patient Outcomes

“…Moreover, this number is predicted to rapidly increase to approximately 6 million by 2050 [ 3 ]. Blood glucose levels should be strictly controlled because diabetes is associated with cardiovascular disease [ 4 ]. Despite the rapid increase in diabetes mellitus (DM) in the Korean population [ 5 6 ], less than 30% of patients with DM achieve a glycosylated hemoglobin (HbA1c) level of 6.5% or lower.…”