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[IP] A1c and your Heart


Glycated Haemoglobin Levels Can Predict Cardiovascular Risk
British Medical Journal

By Harvey McConnell
Glycated haemoglobin concentration, a marker of blood glucose 
concentration, resembles blood pressure and blood cholesterol in terms of 
predicting cardiovascular risks.

These findings have important implications for public health and may 
provide a practical screening tool for diabetes or impaired glucose 
tolerance, suggest researchers at the Department of Public Health and 
Primary Care, Institute of Public Health, University of Cambridge School of 
Clinical Medicine, Cambridge, England.

In a prospective population study researchers enrolled 4,662 men aged 
between 45 and 79 drawn from 25,623 men and women recruited from 
family doctor lists and who make up the European Prospective Investigation 
of Cancer and Nutrition in Norfolk, and who are resident in the English 

All of the men had had glycated haemoglobin (HbA1c) measured at the 
baseline survey in 1995-97 and were followed up to December 1999. 

Men with known diabetes were found to have increased mortality from all 
causes, cardiovascular disease and ischaemic disease compared with men 
without known diabetes. 

This increased risk of death among men with diabetes was largely 
explained by HbA1c concentration, researchers point out. In addition, 
"HbA1c was continuously related to subsequent all cause, cardiovascular 
and ischaemic heart disease mortality through the whole population 
distribution, with lowest rates in those with HbA1c concentrations below five 

Researchers note that an increase of one percent in HbA1c level was 
associated with a 28 percent increase in risk of death independent of age, 
blood pressure, serum cholesterol, body mass index and cigarette smoking.

HbA1c concentration seems to resemble blood pressure and blood 
cholesterol in terms of the continuous relation with cardiovascular risk, the 
researchers declare. From the public health point of view, a reduction of just 
0.1 percent or 0.2 percent blood glucose concentration in the whole 
population would reduce total mortality by five percent to 10 percent, 

The Cambridge researchers point out that the global prevalence of diabetes 
is predicted to rise from 135 million in 1995 to 300 million by 2025.

"Whether it is possible to shift the whole population distribution of glycated 
haemoglobin concentration is unknown," the researchers comment. 
"However, huge secular trends and migrant studies showing rapidly 
increasing prevalence of diabetes suggest that glucose tolerance in the 
population is susceptible to environmental changes and may be viewed as 
a societal problem."

Studies have implicated nutrition and physical activity as important 
determinants of diabetes and glycaemia in various populations. 

"The challenge is to identify how much risk can be affected by small 
changes in the determinants of glycaemia at the population level and to 
devise strategies for bringing about these changes," the researchers 

BMJ 2001;322:15-18. 
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