GHb Is a Better Predictor of Cardiovascular Disease Than Fasting or Postchallenge Plasma Glucose in Women Without Diabetes: The Rancho Bernardo Study
Abstract
OBJECTIVE: To examine the relation between GHb, fasting plasma glucose (FPG), postchallenge plasma glucose (PCPG), and mortality from cardiovascular disease (CVD) and ischemic heart disease (IHD) in older adults. RESEARCH DESIGN AND METHODS: A community-based study of 1,239 nondiabetic older adults followed for an average of 8 years, from baseline (1984–1987) to 1993. RESULTS: GHb, but not FPG or PCPG, was significantly related to CVD and IHD mortality in women but not men. The age-adjusted relative hazard for those in the highest quintile of GHb (≥ 6.7%) compared with women with lower levels was 2.37 for fatal CVD (95% CI = 1.30−4.31, P = 0.005) and 2.43 for IHD (95% CI = 1.12−5.25, P = 0.024). This association persisted after adjustment for all covariates (age, systolic blood pressure, BMI, LDL, HDL, triglycerides, cigarette smoking, antihypertensive medication use, and estrogen use). GHb was significantly associated with LDL and HDL levels in women, but the association between GHb and CVD or IHD persisted after adjustment for these lipoproteins. CONCLUSIONS: We concluded that GHb is a better predictor of CVD and IHD mortality than FPG or PCPG in women without diabetes; no single measure of glycemia was predictive in men. The reason for the sex difference is unexplained.
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Even modest elevations in these biomarkers are associated with adverse outcomes, even when they do not meet accepted thresholds for clinical intervention.
“It is important to note that even modest elevations in these biomarkers are associated with adverse outcomes, even when they do not meet accepted thresholds for clinical intervention.21,22”
From Socio‐economic differentials in peripheral biology: Cumulative allostatic load (2010) · cites this paper as [21]
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Koerbel, G. L., & Korytkowski, M. (2003) · Diabetes Spectrum · doi:10.2337/diaspect.16.3.148 · Cited by 26 · see citing works
Adequacy of Glycemic Control in Hemodialysis Patients With Diabetes
Tascona, D. J., Morton, A. R., Toffelmire, E. B., Holland, D. C., & Iliescu, E. A. (2006) · Diabetes Care · doi:10.2337/dc06-0845 · Cited by 26 · see citing works
Fructosamine, glycated hemoglobin, and dietary carbohydrates
Misciagna, G., Logroscino, G., Michele, G. D., Cisternino, A. M., Guerra, V., & Freudenheim, J. L. (2003) · Clinica Chimica Acta · doi:10.1016/j.cccn.2003.10.024 · Cited by 25 · see citing works
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“Irrespective of its diagnostic role, recent studies have focused on its prognostic impact on predicting future occurrence of diabetes, CAD, cardiac and cerebrovascular death [Park et al. 1996; Preis et al. 2009; Selvin et al. 2010; Timmer et al. 2011; Pai et al. 2013].”
BackgroundResultOptimizing the diabetic formulary: beyond aspirin and insulin
Marso, S. P. (2002) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(02)02006-5 · Cited by 23 · see citing works
Eskesen, K., Jensen, M. T., Galatius, S., Vestergaard, H., Hildebrandt, P. R., Marott, J. L., & Jensen, J. S. (2012) · Journal of Internal Medicine · doi:10.1111/j.1365-2796.2012.02594.x · Cited by 23 · see citing works
Cardiovascular Disease, Neuropathy, and Retinopathy
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“In the Rancho Bernardo study, A1C was a better CVD predictor than fasting or 2-h glucose (9); in the Framingham Offspring study CVD risk increased 15% per SD increase in A1C, independent of fasting glucose and 2-h glucose (10); in the Epic-Norfolk study, there was a 1.”
MethodFasting and Post-Challenge Glucose as Quantitative Cardiovascular Risk Factors: A Meta-Analysis
Kodama, S., Saito, K., Tanaka, S., Horikawa, C., Fujiwara, K., Hirasawa, R., Yachi, Y., Sone, Y., Iida, K., Shimano, H., et al. (2012) · Journal of Atherosclerosis and Thrombosis · doi:10.5551/jat.10975 · Cited by 23 · see citing works
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The Effect of Glycemic Control on the Incidence of Macrovascular Complications of Type 2 Diabetes
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“P ro ce ed in gs o f th e N u tr it io n So ci et y Investigation into Cancer and Nutrition((68,69)), Atherosclerosis Risk in Communities study, Australian Diabetes, Obesity and Lifestyle study((74)), the Hoorn Study((75,76)), Framingham Offspring((77)), Rancho Bernardo((78)), Women’s Health Study andNational Survey o…”
Nomani, A. Z., Nabi, S., Ahmed, S., Iqbal, M., Rajput, H. M., & Rao, S. N. C. K. (2016) · Stroke and Vascular Neurology · doi:10.1136/svn-2016-000018 · Cited by 20 · see citing works
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Hormone replacement therapy and glucose tolerance in EPIC-Norfolk: a population-based study
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Coronary risk in South Asians: role of ethnicity and blood sugar
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The role of glucose as an independent cardiovascular risk factor
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Song, D. K., Hong, Y. S., Sung, Y., et al. (2023) · PLoS ONE · doi:10.1371/journal.pone.0283393 · Cited by 15 · see citing works
“HbA1c estimates longterm glucose status and predicts cardiovascular disease better than fasting or post-challenge glucose in women without diabetes mellitus [28].”
BackgroundDoruk, H., Mas, M. R., Ateşkan, Ü., et al. (2005) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2004.11.004 · Cited by 15 · see citing works
- Authors
- Park, S., Barrett-Connor, E., Wingard, D. L., Shan, J., & Edelstein, S.
- Affiliations
- University of California San Diego (US)
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 1996-05-01
- Volume
- 19
- Issue
- 5
- Pages
- 450-456
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2006867892
- Cited by
- 161
- References
- 0
- Citations by year
- 2023: 3 · 2022: 6 · 2020: 5 · 2019: 8 · 2018: 3 · 2017: 2 · 2016: 4 · 2015: 7 · 2014: 7 · 2013: 9 · 2012: 9
- FWCI
- 1.88
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (HL 07491, T35HL007491)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK031801, DK-31801)
- 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 mortality, ischemic heart disease mortality, fasting blood glucose, glycemic markers, sex differences, older women, cardiovascular risk prediction
- MeSH terms
- Adult, Age Factors, Blood Glucose, Blood Pressure, California, Cardiovascular Diseases, Fasting, Female, Glucose Tolerance Test, Heart Diseases, Glycated Hemoglobin, Humans, Cholesterol, HDL, Cholesterol, LDL, Male, Middle Aged, Predictive Value of Tests, Reference Values, Risk Factors, Sex Characteristics, Triglycerides, Biomarkers, Body Mass Index, Myocardial Ischemia, Risk Assessment
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