Haemoglobin A1C for coronary heart disease risk stratification in non-diabetic patients

Human-Hemoglobin Diabetes is one of the top chronic diseases in India and it is well known to have a correlation to coronary heart disease through the Haemoglobin A1C (HbA1C) marker. HbA1C, a clinical marker of glycated haemoglobin, is increasingly being used to diagnose diabetes. As it is a time-integrated marker, it is widely used in evaluating the glycemic control in patients with diabetes. It is well known that HbA1C levels in diabetes predict risk of coronary heart disease (CHD), however, it is unclear whether the same can be used to predict CHD risks in non-diabetic patients. Researchers from the Department of epidemiology, Harvard Medical School, Boston studied two cohorts to address this issue.

Key Point: HbA1C may be an important early clinical marker of CHD risk, even in Indian patients who have not been diagnosed with diabetes. It is established that there is a positive relationship between the level of HbA1C, the severity of diabetes mellitus and the risk of coronary heart disease (CHD). It was unclear if HbA1C was associated with risk of CHD in non-diabetic patients, but this study concluded that HbA1C may be used as an early marker to assess CHD risk in healthy individuals.

The researchers studied the cohort from The Nurses’ Health Study (NHS)-all women, and Health Professionals Follow-up Study (NPFS)-all men, which began in 1976 and 1986 respectively. Over a follow-up period of 14 and 10 years, 468 women and 454 men developed non-fatal myocardial infarction and fatal CHD. They were matched with controls free of CHD on a 1:2 ratio. The controls were randomly selected based on age, smoking and date of blood drawn for the test. Those who had history of diabetes or HbA1C levels ≥ 6.5% were not included in the study for further analysis. The researchers chose ≥ 6.5% as cut off, as that is the recommended level defining diabetes by American Diabetes Association and World Health Organization.

alexander"This is a very interesting paper and could have very important implications especially for countries like India with a very high burden of cardiovascular disease. It would be very interesting to see if there is a correlation with metabolic syndrome. Using HbA1c as a screening test raises interesting possibilities, apart from its obvious utility to diagnose Diabetes Mellitus, that of using it as a marker to target aggressive life style modifications to prevent CHD."
- Dr. Thomas Alexander, MD, DM, FACC, FICC, FCSI, Coimbatore, Tamilnadu, India. Dr. Alexander is an interventional cardiologist who is the Head of the Division of Cardiology at Kovai Medical Center and Hospital in Coimbatore, India and is a member of the mdCurrent-India Editorial Advisory Board.

They found that in cases, cardiovascular risk factors were...

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