Abstract
Objective
To examine the association between hemoglobin A1c (HbA1c) and the presence, severity, and complexity of angiographically proven coronary artery
disease (CAD) in nondiabetic patients.
Patients and Methods
We performed a single-center, observational, cross-sectional study of 1141 consecutive
nondiabetic patients who underwent coronary angiography from January 1, 2011, through
December 31, 2011. The study population was divided into 4 interquartiles according
to HbA1c levels (<5.5%, 5.5%-5.7%, 5.8%-6.1%, and >6.1%).
Results
Patients with higher HbA1c levels tended to be older, overweight, and hypertensive, had higher blood glucose
levels, and had lower glomerular filtration rates. Higher HbA1c levels were associated in a graded fashion with the presence of CAD, disease severity
(higher number of diseased vessels and presence of left main and/or triple vessel
disease), and disease complexity (higher SYNTAX score, higher number of patients in
intermediate or high SYNTAX tertiles, coronary calcium, and chronic total occlusions).
After adjustment for major conventional cardiovascular risk factors, compared with
patients with HbA1c levels less than 5.5%, the odds ratios of occurrence of CAD in the HbA1c quartiles of 5.5% to 5.7%, 5.8% to 6.1%, and greater than 6.1% were 1.8 (95% CI,
1.2-2.7), 3.5 (95% CI, 2.3-5.3), and 4.9 (95% CI, 3.0-8.1), respectively.
Conclusion
The HbA1c level has a linear incremental association with CAD in nondiabetic individuals. The
HbA1c level is also independently correlated with disease severity and higher SYNTAX scores.
Thus, HbA1c measurement could be used to improve cardiovascular risk assessment in nondiabetic
individuals.
Abbreviations and Acronyms:
BMI (body mass index), CAD (coronary artery disease), CVD (cardiovascular disease), e-GFR (estimated glomerular filtration rate), HbA1c (hemoglobin A1c), OR (odds ratio)To read this article in full you will need to make a payment
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Article Info
Footnotes
Dr Moorthy is currently affiliated with the Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India.
Identification
Copyright
© 2014 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
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- Time to Focus on Preventing Coronary Artery Disease Through Exercise Training in Normoglycemic IndividualsMayo Clinic ProceedingsVol. 90Issue 3
- PreviewWe read with interest the article by Garg et al1 on the association of glycosylated hemoglobin (HbA1c) with coronary artery disease (CAD) risk and severity in nondiabetic patients. As expected, as individuals approached the diabetic threshold as defined by HbA1c level, the more likely CAD was present and in a more severe form. These findings reiterate the role of chronically elevated blood glucose concentrations in the development and progression of CAD.
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