| Title |
HbA1c levels in non-diabetic older adults – No J-shaped associations with primary cardiovascular events, cardiovascular and all-cause mortality after adjustment for confounders in a meta-analysis of individual participant data from six cohort studies
|
|---|---|
| Published in |
BMC Medicine, February 2016
|
| DOI | 10.1186/s12916-016-0570-1 |
| Pubmed ID | |
| Authors |
Ben Schöttker, W. Rathmann, C. Herder, B. Thorand, T. Wilsgaard, I. Njølstad, G. Siganos, E. B. Mathiesen, K. U. Saum, A. Peasey, E. Feskens, P. Boffetta, A. Trichopoulou, K. Kuulasmaa, F. Kee, H. Brenner, on behalf of the CHANCES group |
| Abstract |
To determine the shape of the associations of HbA1c with mortality and cardiovascular outcomes in non-diabetic individuals and explore potential explanations. The associations of HbA1c with all-cause mortality, cardiovascular mortality and primary cardiovascular events (myocardial infarction or stroke) were assessed in non-diabetic subjects ≥50 years from six population-based cohort studies from Europe and the USA and meta-analyzed. Very low, low, intermediate and increased HbA1c were defined as <5.0, 5.0 to <5.5, 5.5 to <6.0 and 6.0 to <6.5 % (equals <31, 31 to <37, 37 to <42 and 42 to <48 mmol/mol), respectively, and low HbA1c was used as reference in Cox proportional hazards models. Overall, 6,769 of 28,681 study participants died during a mean follow-up of 10.7 years, of whom 2,648 died of cardiovascular disease. Furthermore, 2,493 experienced a primary cardiovascular event. A linear association with primary cardiovascular events was observed. Adjustment for cardiovascular risk factors explained about 50 % of the excess risk and attenuated hazard ratios (95 % confidence interval) for increased HbA1c to 1.14 (1.03-1.27), 1.17 (1.00-1.37) and 1.19 (1.04-1.37) for all-cause mortality, cardiovascular mortality and cardiovascular events, respectively. The six cohorts yielded inconsistent results for the association of very low HbA1c levels with the mortality outcomes and the pooled effect estimates were not statistically significant. In one cohort with a pronounced J-shaped association of HbA1c levels with all-cause and cardiovascular mortality (NHANES), the following confounders of the association of very low HbA1c levels with mortality outcomes were identified: race/ethnicity; alcohol consumption; BMI; as well as biomarkers of iron deficiency anemia and liver function. Associations for very low HbA1c levels lost statistical significance in this cohort after adjusting for these confounders. A linear association of HbA1c levels with primary cardiovascular events was observed. For cardiovascular and all-cause mortality, the observed small effect sizes at both the lower and upper end of HbA1c distribution do not support the notion of a J-shaped association of HbA1c levels because a certain degree of residual confounding needs to be considered in the interpretation of the results. |
X Demographics
The data shown below were collected from the profiles of 7 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United Kingdom | 3 | 43% |
| Sweden | 1 | 14% |
| Unknown | 3 | 43% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 6 | 86% |
| Practitioners (doctors, other healthcare professionals) | 1 | 14% |
Mendeley readers
The data shown below were compiled from readership statistics for 80 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 80 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Ph. D. Student | 11 | 14% |
| Researcher | 11 | 14% |
| Other | 8 | 10% |
| Student > Master | 6 | 8% |
| Professor | 6 | 8% |
| Other | 18 | 23% |
| Unknown | 20 | 25% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 32 | 40% |
| Nursing and Health Professions | 6 | 8% |
| Biochemistry, Genetics and Molecular Biology | 4 | 5% |
| Mathematics | 2 | 3% |
| Agricultural and Biological Sciences | 2 | 3% |
| Other | 7 | 9% |
| Unknown | 27 | 34% |
Attention Score in Context
This research output has an Altmetric Attention Score of 3. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 23 January 2022.
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#7,658,506
of 23,314,015 outputs
Outputs from BMC Medicine
#2,656
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Outputs of similar age
#128,922
of 402,953 outputs
Outputs of similar age from BMC Medicine
#43
of 56 outputs
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