Haemoglobin A1c even within non-diabetic level is a predictor of cardiovascular disease in a general Japanese population: the Hisayama Study
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BACKGROUND: There is little information about predictive ability of haemoglobin A1c (HbA1c) for cardiovascular disease (CVD) in Asians. To investigate the discriminatory ability of HbA1c to identify subjects who are at greater risk of developing CVD in a prospective study of a defined community-dwelling Japanese population. METHODS: A total of 2,851 subjects aged 40-79 years were stratified into five groups (HbA1c levels with ≤ 5.0, 5.1-5.4, 5.5-6.4, and ≥ 6.5% and a group with antidiabetic medication) and followed up prospectively for 7 years (2002-2009). RESULTS: During the follow-up, 119 subjects developed CVD. The multivariable-adjusted risk of CVD was significantly increased in subjects with HbA1c levels of 5.5-6.4 and ≥ 6.5% and diabetic medication compared to HbA1c level with ≤ 5.0% (hazard ratio, 2.26 [95% confidence interval, 1.29-3.95] for the 5.5-6.4%; 4.43 [2.09-9.37] for the ≥ 6.5%; and 5.15 [2.65-10.0] for the antidiabetic medication group). With regard to CVD subtype, the positive associations between HbA1c levels and the risk of coronary heart disease (CHD) and ischaemic stroke were also significant, but no such associations were seen for haemorrhagic stroke. The C statistic for developing CVD was significantly increased by adding HbA1c values to the model including other risk factors (0.789 vs. 0762, p = 0.006), and the net reclassification improvement was 0.105 (p = 0.004). CONCLUSIONS: Our findings suggest that elevated HbA1c levels are an independent risk factor for CVD, especially CHD and ischaemic stroke, and that the addition of HbA1c to the model with traditional risk factors significantly improves the predictive ability of CVD.
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The risk of CVD begins to increase since the impaired glucose tolerance state.
“The risk of CVD begins to increase since impaired glucose tolerance (IGT) state144).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [144]
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- Authors
- Ikeda, F., Doi, Y., Ninomiya, T., Hirakawa, Y., Mukai, N., Hata, J., Shikata, K., Yoshida, D., Matsumoto, T., Kitazono, T., & Kiyohara, Y.
- Affiliations
- Kyushu University (JP)
- Corresponding author
- Ikeda, Fumie
- ORCID
- Venue
- Cardiovascular Diabetology
- Published
- 2013
- Volume
- 12
- Issue
- 1
- Pages
- 164
- ISSN
- 1475-2840 (ISSN-L)
- PMC
- PMC4176981
- OpenAlex
- W2103908162
- Cited by
- 67
- References
- 44
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 5 · 2023: 5 · 2022: 7 · 2021: 4 · 2020: 5 · 2019: 4 · 2018: 6 · 2017: 8 · 2016: 6 · 2015: 9 · 2014: 3
- FWCI
- 4.72
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Cardiovascular Diabetology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Ministry of Education, Culture, Sports, Science and Technology (22116010, 25460758, 25253048, 25293428)
- Ministry of Health, Labour and Welfare (H25‐Junkankitou [Seishuu]‐Sitei‐022, H25-Junkankitou, H25-Ninchisho-Ippan-004, H23–Junkankitou [Seishuu]–Ippan–005)
- Japan Society for the Promotion of Science (22116001, 23590798, 25253048, 24590796, 25293428, 25460758, 23500842, 24590797, 22240073, 23590797)
- 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, cardiovascular disease, coronary artery disease, ischemic stroke, hemorrhagic stroke, cardiovascular risk prediction, antidiabetic drugs, Hisayama Study, Japanese population
- MeSH terms
- Adult, Aged, Aged, 80 and over, Cardiovascular Diseases, Coronary Disease, Diabetes Mellitus, Female, Glycated Hemoglobin, Humans, Hyperglycemia, Hypoglycemic Agents, Japan, Longitudinal Studies, Male, Middle Aged, Prospective Studies, Risk Factors, Multivariate Analysis, Proportional Hazards Models, Stroke, Asian People
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