High Glycosylated Hemoglobin Tied to All-Cause and Cardiovascular Mortality

In a study of type 1 diabetics, the highest glycosylated hemoglobin levels compared with the lowest levels were associated with more than double the mortality risk from any cause and more than triple the risk of death due cardiovascular disease.

Dr. Shankar’s team studied 879 type 1 diabetics living in Wisconsin, enrolled between 1980 and 1982 and followed through 2001. All were free of cardiovascular disease and end-stage renal disease at baseline.
Patients with glycosylated hemoglobin levels in the highest quartile (12.1% or higher) had a relative risk of 2.42 for all-cause mortality and 3.28 for cardiovascular disease compared with those in the lowest quartile (9.4% or lower).
Dr. Shankar said, "This association appeared to be independent of several confounding factors, including age of subjects, duration of diabetes, body mass index, proteinuria, and cholesterol levels."

The implication of these results "is that the current recommendation for near-normal glycemic control, in addition to preventing microvascular complications, may also enhance survival in individuals with type 1 diabetes," Dr. Shankar proposed. "However, since ours is not a randomized interventional trial, we cannot provide this as direct evidence."
The investigators acknowledge that "it is possible that our results were biased by residual confounding by factors not measured in the study but potentially related to cardiovascular disease in type 1 diabetes, including plasma triglycerides, lipoprotein subclasses, and markers of endothelial dysfunction."

Publishers Note:  In the Epic-Norfolk Study it was found from an analysis of over 5000 women and 4500 men that, those with an A1c of 6% compared to those with a 5% A1c had a 28% higher risk for cardiovascular death.

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