Cited by 261Diabetes, Cardiovascular Risks, and LipoproteinsDiabetes Management and ResearchDiabetes Treatment and Management

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Glycated haemoglobin A1c as a risk factor of cardiovascular outcomes and all-cause mortality in diabetic and non-diabetic populations: a systematic review and meta-analysis

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Cavero-Redondo, Iván, Peleteiro, Barbara, Álvarez-Bueno, Celia, Rodriguez-Artalejo, Fernando, Martínez-Vizcaíno, Vicente·2017·BMJ Open

DOI 10.1136/bmjopen-2017-015949PMC PMC5642750

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Abstract

OBJECTIVE: To examine the relationship between glycated haemoglobin A1c (HbA1c) levels and the risk of cardiovascular outcomes and all-cause mortality based on data from observational studies and to determine the optimal levels of HbA1c for preventing cardiovascular events and/or mortality in diabetic and non-diabetic populations. REVIEW METHODS: We systematically searched Medline, Embase, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews and Web of Science databases, from inception to July 2016, for observational studies addressing the association of HbA1c levels with mortality and cardiovascular outcomes. Random effects models were used to compute pooled estimates of HR and respective 95% CI for all-cause mortality, cardiovascular mortality and risk of cardiovascular events, separately for people with and without diabetes. RESULTS: Seventy-four published studies were included in the systematic review, but only 46 studies could be incorporated in the meta-analysis. In both diabetic and non-diabetic populations, there was an increase in the risk of all-cause mortality when HbA1c levels were over 8.0% and 6.0%, respectively. The highest all-cause mortality in people with diabetes was HbA1c above 9.0% (HR=1.69; 95% CI 1.09 to 2.66) and in those without diabetes was HbA1c above 6.0% (HR=1.74; 95% CI 1.38 to 2.20). However, both diabetic and non-diabetic populations with lower HbA1c levels (below 6.0% HR=1.57; 95% CI 1.14 to 2.17 and below 5.0% HR=1.19; 95% CI 1.04 to 1.36, respectively) had higher all-cause mortality. Similar pooled estimates were found when cardiovascular mortality was the outcome variable. CONCLUSION: HbA1c is a reliable risk factor of all-cause and cardiovascular mortality in both diabetics and non-diabetics. Our findings establish optimal HbA1c levels, for the lowest all-cause and cardiovascular mortality, ranging from 6.0% to 8.0% in people with diabetes and from 5.0% to 6.0% in those without diabetes.

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Authors: Cavero-Redondo, I., Peleteiro, B., Álvarez-Bueno, C., Rodriguez-Artalejo, F., & Martínez-Vizcaíno, V.
Affiliations: Universidad de Castilla—La Mancha, Health and Social Research Center, Cuenca, Spain
EPI Unit, Instituto de Saúde Pública,Universidade do Porto, Porto, Portugal
Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/ IdiPaz, CIBERESP, and IMDEA-Food Institute. CEI UAM+CSIC, Madrid, Spain
Venue: BMJ Open
Publisher: BMJ
Published: 2017-07
Volume: 7
Issue: 7
Pages: e015949
ISSN: 2044-6055 (ISSN-L)
DOI: 10.1136/bmjopen-2017-015949
PMC: PMC5642750
OpenAlex: W2739699420
Cited by: 260
References: 46
Citations by year: 2026: 13 · 2025: 26 · 2024: 27 · 2023: 46 · 2022: 45 · 2021: 44 · 2020: 26 · 2019: 24 · 2018: 8 · 2017: 1
FWCI: 2.35
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by-nc
Locations: BMJ Open (publishedVersion, cc-by-nc)
PubMed Central (publishedVersion, cc-by-nc)
PubMed (publishedVersion)
LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, other-oa)
HighWire Press Open Archive (submittedVersion)
Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, other-oa)
Funders: Universidad de Castilla-La Mancha (FPU13/01582, FPU13/03137)
Fundação para a Ciência e a Tecnologia (SFRH/BPD/108751/2015)
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: glycated haemoglobin A1c, HbA1c targets, all-cause mortality, cardiovascular mortality, cardiovascular events, diabetes mellitus, glycemic control, cardiovascular risk factors, non-diabetic population, HbA1c thresholds, cardiovascular disease prevention
MeSH terms: Cardiovascular Diseases, Diabetes Mellitus, Type 2, Glycated Hemoglobin, Humans, Risk Factors, Observational Studies as Topic

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Glycated haemoglobin A1c as a risk factor of cardiovascular outcomes and all-cause mortality in diabetic and non-diabetic populations: a systematic review and meta-analysis

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