Hemoglobin A1c predicts diabetes but not cardiovascular disease in nondiabetic women
Open accessAbstract
Background Hemoglobin A1c (HbA1c) is a marker of cumulative glycemic exposure over the preceding 2- to 3-month period. Whether mild elevations of this biomarker provide prognostic information for development of clinically evident type 2 diabetes and cardiovascular disease among individuals at usual risk for these disorders is uncertain. Methods We examined baseline HbA1c levels as a predictor of incident clinical diabetes and cardiovascular disease (nonfatal myocardial infarction, coronary revascularization procedure, ischemic stroke, or death from cardiovascular causes) in a prospective cohort study beginning in 1992 of 26,563 US female health professionals aged 45 years or more without diagnosed diabetes or vascular disease (median follow-up 10.1 years). Results During follow-up, 1238 cases of diabetes and 684 cardiovascular events occurred. In age-adjusted analyses using quintiles of HbA1c, a risk gradient was observed for both incident diabetes and cardiovascular disease. After multivariable adjustment, HbA1c remained a strong predictor of diabetes but was no longer significantly associated with incident cardiovascular disease. In analyses of threshold effects, adjusted relative risks for incident diabetes in HbA1c categories of less than 5.0%, 5.0% to 5.4%, 5.5% to 5.9%, 6.0% to 6.4%, 6.5% to 6.9%, and 7.0% or more were 1.0, 2.9, 12.1, 29.3, 28.2, and 81.2, respectively. Risk associations persisted after additional adjustment for C-reactive protein and after excluding individuals developing diabetes within 2 and 5 years of follow-up. Conclusions These prospective findings suggest that HbA1c levels are elevated well in advance of the clinical development of type 2 diabetes, supporting recent recommendations for lowering of diagnostic thresholds for glucose metabolic disorders. In contrast, the association of HbA1c with incident cardiovascular events is modest and largely attributable to coexistent traditional risk factors.
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Incidence of diabetes in people with A1C levels in the 6.0 to <6.5% range is more than 10 times that of people with lower levels.
“Indeed, incidence of diabetes in people with A1C levels in this range is more than 10 times that of people with lower levels (4–7).”
From Diagnosis and classification of diabetes mellitus (2013) · cites this paper as [5]
People within the A1C range of 5.5-6.0% have a 5-year cumulative incidence of diabetes that ranges from 12 to 25%.
“Prospective studies indicate that people within the A1C range of 5.5–6.0% have a 5-year cumulative incidence of diabetes that ranges from 12 to 25% (4–7), which is appreciably (three- to eightfold) higher than incidence in the U.S. population as a whole (8).”
From Diagnosis and classification of diabetes mellitus (2013) · cites this paper as [5]
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- Authors
- Pradhan, A. D., Rifai, N., Buring, J. E., & Ridker, P. M.
- Affiliations
- Boston Medical Center (US)
- Brigham and Women's Hospital (US)
- Corresponding author
- Pradhan, Aruna D.
- Venue
- The American Journal of Medicine
- Publisher
- Elsevier BV
- Published
- 2007-08
- Volume
- 120
- Issue
- 8
- Pages
- 720-727
- ISSN
- 0002-9343 (ISSN-L)
- PMC
- PMC2585540
- OpenAlex
- W2013253830
- Cited by
- 189
- References
- 44
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 5 · 2023: 6 · 2022: 3 · 2021: 9 · 2020: 8 · 2019: 7 · 2018: 6 · 2017: 7 · 2016: 10 · 2015: 19 · 2014: 14 · 2013: 16 · 2012: 17
- FWCI
- 8.56
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The American Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Donald W. Reynolds Foundation
- National Institutes of Health (5r01hl043851-10)
- National Heart, Lung, and Blood Institute (R01HL058755, R01‐HL043851, HL43851, HL-58755)
- National Cancer Institute (CA-47988, R01CA047988)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- HbA1c, type 2 diabetes, cardiovascular disease, non-diabetic women, diabetes prediction, cardiovascular risk, glycemic exposure, C-reactive protein, myocardial infarction, ischemic stroke, coronary revascularization, cardiovascular mortality
- MeSH terms
- Cardiovascular Diseases, Diabetes Mellitus, Type 2, Diabetic Angiopathies, Female, Follow-Up Studies, Glycated Hemoglobin, Humans, Middle Aged, Predictive Value of Tests, Prognosis, Prospective Studies, Incidence, Risk Assessment
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