A1C Is Coronary Disease Predictor Even for Those Without Diabetes

Glycated hemoglobin (A1C) is a useful and reliable risk indicator for developing CHD, even in people without diabetes whose A1C levels are in the high normal range. Chronic hyperglycemia has long been a suspected culprit in the development of coronary heart disease (CHD). As a marker of long-term glycemic control, glycated hemoglobin (A1C) is a useful and reliable risk indicator for developing CHD, even in people without diabetes whose A1C levels are in the high normal range.

The researchers conducted a prospective study of 1,321 adults without diabetes and a cohort of 1,626 adults with diabetes in the Atherosclerosis Risk in Communities Study. CHD and other outcomes were tallied for an 8- to 10-year follow-up period.
Overall, researchers found that those with diabetes who had the highest A1C levels were more than twice as likely to develop CHD than those with the lowest A1C levels.

Among subjects without diabetes, those with the highest levels of A1C were about 1.5 times more likely to develop CHD than nondiabetic patients with the lowest levels. No greater risk of CHD was noted at A1C levels 4.6% in this group, while risk of CHD increased significantly when A1C levels were 4.6%. Each 1% increase in A1C over 4.6% raised the risk of CHD nearly 2.5 times, according to researchers.

Selvin E, Coresh J, Golden SH, et al.: Glycemic control and coronary heart disease risk in persons with and without diabetes: The Atherosclerosis Risk in Communities Study. Arch Intern Med 16:1910–1916, 2005.

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FACT:
Trans Fats Judged Major Villain in Cardiovascular Disease: Consumption of trans fatty acids raised lipid levels and increases the risk of coronary heart disease, sudden death from cardiac causes, and possibly diabetes, according to a review article. The risk of coronary heart disease increased 23%. Sudden death from a cardiac event was up 47% and tripled when evaluated for certain trans-fat isomers. In fact, the adverse health effects of trans fatty acids, still dangerously high in the U.S., are far stronger on average than those of food contaminants or pesticide residues, which have received considerably more attention, said Dariush Mozaffarian, M.D., at the Harvard School of Public Health, and colleagues including Walter Willett, M.D., and Meir Stampfer, M.D. Trans fats, unsaturated fatty acids with at least one double bond in the trans configuration, are formed during the partial hydrogenation of vegetable oils, a process that converts these oils into the semisolid fats found in deep-fried foods, bakery products, packaged snack food, margarines, and crackers, the researchers said. Trans Fatty Acids and Cardiovascular Disease," New England Journal of Medicine 2006; 354:1601-1613