The association of hemoglobin a1c with incident heart failure among people without diabetes: the Atherosclerosis Risk in Communities Study
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OBJECTIVE: This study sought to investigate an association of HbA1c (A1C) with incident heart failure among individuals without diabetes and compare it to fasting glucose. RESEARCH DESIGN AND METHODS: We studied 11,057 participants of the Atherosclerosis Risk in Communities (ARIC) Study without heart failure or diabetes at baseline and estimated hazard ratios of incident heart failure by categories of A1C (<5.0, 5.0-5.4 [reference], 5.5-5.9, and 6.0-6.4%) and fasting glucose (<90, 90-99 [reference], 100-109, and 110-125 mg/dl) using Cox proportional hazards models. RESULTS: A total of 841 cases of incident heart failure hospitalization or deaths (International Classification of Disease, 9th/10th Revision, 428/I50) occurred during a median follow-up of 14.1 years (incidence rate 5.7 per 1,000 person-years). After the adjustment for covariates including fasting glucose, the hazard ratio of incident heart failure was higher in individuals with A1C 6.0-6.4% (1.40 [95% CI, 1.09-1.79]) and 5.5-6.0% (1.16 [0.98-1.37]) as compared with the reference group. Similar results were observed when adjusting for insulin level or limiting to heart failure cases without preceding coronary events or developed diabetes during follow-up. In contrast, elevated fasting glucose was not associated with heart failure after adjustment for covariates and A1C. Similar findings were observed when the top quartile (A1C, 5.7-6.4%, and fasting glucose, 108-125 mg/dl) was compared with the lowest quartile (<5.2% and <95 mg/dl, respectively). CONCLUSIONS: Elevated A1C (> or =5.5-6.0%) was associated with incident heart failure in a middle-aged population without diabetes, suggesting that chronic hyperglycemia prior to the development of diabetes contributes to development of heart failure.
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Patients with pre-diabetes in the ARIC study also had more HF than those without pre-diabetes.
“Patients with pre-diabetes in the ARIC study also had more HF than those without pre-diabetes.68”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [68]
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- Authors
- Matsushita, K., Blecker, S., Pazin-Filho, A., Bertoni, A., Chang, P. P., Coresh, J., & Selvin, E.
- Affiliations
- Johns Hopkins University (US)
- Medical School of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil;
- Wake Forest University Health Sciences (US)
- University of North Carolina at Chapel Hill (US)
- Corresponding author
- Matsushita, Kunihiro
- Venue
- Diabetes
- Publisher
- American Diabetes Association
- Published
- 2010-05-18
- Volume
- 59
- Issue
- 8
- Pages
- 2020-2026
- ISSN
- 0012-1797 (ISSN-L)
- 1939-327X
- PMC
- PMC2911067
- OpenAlex
- W2126483958
- Cited by
- 183
- References
- 41
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 6 · 2023: 11 · 2022: 8 · 2021: 15 · 2020: 19 · 2019: 18 · 2018: 8 · 2017: 7 · 2016: 13 · 2015: 16 · 2014: 15 · 2013: 12 · 2012: 6
- FWCI
- 8.44
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diabetes (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Scientific Electronic Library Online (São Paulo Research Foundation, Latin American and Caribbean Center on Health Sciences Information, Conselho Nacional de Desenvolvimento Científico e Tecnológico) (publishedVersion)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
- UNC Libraries
- Funders
- National Institutes of Health (n01hc55021-47-0-1, n01hc55020-39-0-0, n01hc55016-37-0-0, n01hc055022-024, n01hc55019-35-0-1, n01hc55018-38-0-1, 5r01dk076770-05, N01-HC55020, N01-HC-55021, N01-HC-55019, N01-HC-55022, N01-HC55016, N01-HC55018, N01-HC-55015, n01hc55015-48-0-1)
- Agency for Healthcare Research and Quality (K08HS023683)
- National Heart, Lung, and Blood Institute (N01-HC55022, N01 HC055016, N01-HC-55018, N01 HC 55020, N01-HC-55015, N01-HC-55016, N01-HC-55018, N01-HC-55019, N01-HC-55020, N01-HC-55021, and N01-HC-55022, N01 HC 55019, N01 HC055020, N01 HC055018, N01-HC55016, N01 HC055022, N01 HC055019, N01‐HC‐55015, N01-HC55021, N01 HC055021, N01 HC055015, T32HL007024)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01-DK076770, N01-HC-55016, N01-HC-55018, K01DK076595, N01-HC-55021, N01-HC-55020, N01-HC-55015, N01-HC-55019, N01-HC-55022, R21DK080294)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- HbA1c, incident heart failure, fasting blood glucose, hyperglycemia, prediabetes, non-diabetic individuals, chronic hyperglycemia, insulin, Atherosclerosis Risk in Communities Study
- MeSH terms
- Blood Glucose, Diabetes Mellitus, Educational Status, Fasting, Female, Heart Failure, Glycated Hemoglobin, Humans, Insulin, Male, Middle Aged, Reference Values, Risk Factors, United States, Cohort Studies, Proportional Hazards Models, Atherosclerosis
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