J Lipid Atheroscler.  2015 Dec;4(2):123-130. 10.12997/jla.2015.4.2.123.

Increased Estimated 10-Year Risk for Cardiovascular Disease Assessed Using the Pooled Cohort Equation in Non-Diabetic Subjects According to Increasing HbA1c Levels

• Oh HG
• Rhee EJ

• KMID: 2151820
• DOI: http://doi.org/10.12997/jla.2015.4.2.123

Abstract

OBJECTIVE
In 2013, a new risk calculator known as the Pooled Cohort Equation (PCE) was introduced with the new cholesterol guideline. We aimed to calculate the 10-year atherosclerotic cardiovascular disease (ASCVD) risk using PCE in non-diabetic Korean subjects with glycated hemoglobin (HbA1c) lower than 6.5%.
METHODS
A total of 17,519 participants were evaluated in a health screening program. The 10-year ASCVD risk was calculated using the PCE. Subjects with underlying diabetes or HbA1c > or =6.5% were excluded. Subjects were divided into four groups according to fasting blood glucose (FBG) and HbA1c levels: FBG <100 mg/dL, 100< or =FBG<110 mg/dL, 110< or =FBG<120 mg/dL, and FBG > or =120 mg/dL; HbA1c <5.5%, 5.5%< or =HbA1c<5.6%, 5.6%< or =HbA1c<5.8%, and HbA1c > or =5.8%.
RESULTS
The mean 10-year ASCVD risk significantly increased as FBG increased from <100 mg/dL to >120 mg/dL in the four divided groups (2.6%, 3.3%, 3.8%, 4.1%; p<0.01), and as HbA1c increased from <5.5% to >5.8% (2.4%, 2.7%, 3.0%, 3.6%; p<0.01). The odds ratio for 10-year ASCVD risk > or =10% significantly increased from group I to IV according to FBG and HbA1c levels after adjusting for age, body mass index and fasting insulin level (1.187, 1.753, and 2.390 vs. 1.0 in the lowest FBG group; 1.626, 1.574, and 1.645 vs. 1.0 in the lowest HbA1c group).
CONCLUSION
The 10-year ASCVD risk calculated using the PCE significantly increased as the FBG and HbA1c increased even in Korean subjects without underlying diabetes.

Keyword

Pooled Cohort Equation; 10-year cardiovascular disease risk; Prediabetes

MeSH Terms

Blood Glucose
Body Mass Index
Cardiovascular Diseases*
Cholesterol
Cohort Studies*
Fasting
Hemoglobin A, Glycosylated
Insulin
Mass Screening
Odds Ratio
Prediabetic State
Blood Glucose
Cholesterol
Insulin

Reference

1. Standards of medical care in diabetes--2015: summary of revisions. Diabetes Care. 2015; 38:Suppl. S4.

2. International Diabetes Federation. IDF diabetes atlas. 6th ed [Internet]. Brussels: International Diabetes Federation;2013. cited 2015 Apr 6. Available from: http://www.idf.org/sites/default/files/EN_6E_Atlas_Full_0.pdf.

3. Glucose tolerance and mortality: comparison of WHO and American Diabetes Association diagnostic criteria. The DECODE study group. European Diabetes Epidemiology Group. Diabetes Epidemiology: Collaborative analysis Of Diagnostic criteria in Europe. Lancet. 1999; 354:617–621.

4. Nakagami T. DECODA Study Group. Hyperglycaemia and mortality from all causes and from cardiovascular disease in five populations of Asian origin. Diabetologia. 2004; 47:385–394.

5. D'Agostino RB Sr, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008; 117:743–753.

6. Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014; 129:S1–S45.

7. Goff DC Jr, Lloyd-Jones DM, Bennett G, Coady S, D'Agostino RB Sr, Gibbons R, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014; 63:2935–2959.

8. National Glycohemoglobin Standardization Program. List of NGSP certified methods [Internet]. place unknown: National Glycohemoglobin Standardization Program;cited 2015 Nov 16. Available from: http://www.ngsp.org/docs/methods.pdf.

9. Schwartz KL, Monsur JC, Bartoces MG, West PA, Neale AV. Correlation of same-visit HbA1c test with laboratorybased measurements: a MetroNet study. BMC Fam Pract. 2005; 6:28.

10. Barr EL, Boyko EJ, Zimmet PZ, Wolfe R, Tonkin AM, Shaw JE. Continuous relationships between non-diabetic hyperglycaemia and both cardiovascular disease and all-cause mortality: the Australian Diabetes, Obesity, and Lifestyle (AusDiab) study. Diabetologia. 2009; 52:415–424.

11. Selvin E, Steffes MW, Zhu H, Matsushita K, Wagenknecht L, Pankow J, et al. Glycated hemoglobin, diabetes, and cardiovascular risk in nondiabetic adults. N Engl J Med. 2010; 362:800–811.

12. Wilson PW, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998; 97:1837–1847.

13. Borch-Johnsen K, Colagiuri S, Balkau B, Glümer C, Carstensen B, Ramachandran A, et al. Creating a pandemic of prediabetes: the proposed new diagnostic criteria for impaired fasting glycaemia. Diabetologia. 2004; 47:1396–1402.

14. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998; 15:539–553.

15. Ford ES, Zhao G, Li C. Pre-diabetes and the risk for cardiovascular disease: a systematic review of the evidence. J Am Coll Cardiol. 2010; 55:1310–1317.

16. Bur A, Herkner H, Woisetschläger C, Vlcek M, Derhaschnig U, Hirschl MM. Is fasting blood glucose a reliable parameter for screening for diabetes in hypertension? Am J Hypertens. 2003; 16:297–301.

17. Ghazanfari Z, Haghdoost AA, Alizadeh SM, Atapour J, Zolala F. A comparison of HbA1c and fasting blood sugar tests in general population. Int J Prev Med. 2010; 1:187–194.