HbA1c and fasting plasma glucose levels are equally related to incident cardiovascular risk in a high CVD risk population without known diabetes

UCC-SMART Study Group, Riemer A Been*, Ellen Noordstar, Marga A G Helmink, Thomas T van Sloten, Wendela L de Ranitz-Greven, André P van Beek, Sebastiaan T Houweling, Peter R van Dijk, Jan Westerink

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

OBJECTIVES: Type 2 diabetes (T2DM) is associated with increased risk for cardiovascular disease (CVD). Whether screen-detected T2DM, based on fasting plasma glucose (FPG) or on HbA 1c, are associated with different risks of incident CVD in high-risk populations and which one is preferable for diabetes screening in these populations, remains unclear.

METHODS: 8,274 high-risk CVD participants were included from the UCC-SMART cohort. Participants were divided into groups based on prior T2DM diagnosis, and combinations of elevated/non-elevated FPG and HbA 1c (cut-offs at 7 mmol/L and 48 mmol/mol, respectively): Group 0: known T2DM; group 1: elevated FPG/HbA 1c; group 2: elevated FPG, non-elevated HbA 1c; group 3: non-elevated FPG, elevated HbA 1c; group 1 + 2: elevated FPG, regardless of HbA 1c; group 1 + 3: elevated HbA 1c, regardless of FPG; and group 4 (reference), non-elevated FPG/HbA 1c.

RESULTS: During a median follow-up of 6.3 years (IQR 3.3-9.8), 712 cardiovascular events occurred. Compared to the reference (group 4), group 0 was at increased risk (HR 1.40; 95 % CI 1.16-1.68), but group 1 (HR 1.16; 95 % CI 0.62-2.18), 2 (HR 1.18; 95 % CI 0.84-1.67), 3 (HR 0.61; 95 % CI 0.15-2.44), 1 + 2 (HR 1.17; 95 % CI 0.86-1.59) and 1 + 3 (HR 1.01; 95 % CI 0.57-1.79) were not. However, spline interpolation showed a linearly increasing risk with increasing HbA 1c/FPG, but did not allow for identification of other cut-off points.

CONCLUSIONS: Based on current cut-offs, FPG and HbA 1c at screening were equally related to incident CVD in high-risk populations without known T2DM. Hence, neither FPG, nor HbA 1c, is preferential for diabetes screening in this population with respect to risk of incident CVD.

Original languageEnglish
JournalDiagnosis (Berlin, Germany)
DOIs
Publication statusE-pub ahead of print - 29-Feb-2024

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