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HbA1c a promising predictor of CVD risk in patients with diabetes

Paynter NP. Arch Intern Med. 2011;doi:10.1001/archinternmed.2011.351.

Pletcher MJ. Arch Intern Med. 2011;doi:10.1001/archinternmed.2011.352.

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Compared with the currently recommended classification of diabetes as a cardiovascular risk equivalent, HbA1c proved to be a significant improvement in predicting CVD risk among men and women with diabetes in a recent study.

The study involved 24,674 women with diabetes (n=685) from the Women’s Health Study and 11,280 men with diabetes (n=563) from the Physician’s Health Study II who were followed prospectively for incident CVD, which included myocardial infarction, ischemic stroke, coronary revascularization or CV death. Diabetes information was collected from participants via self-report.

Over a median follow-up of 10.2 years in women, a total of 125 CV events were reported, whereas 170 events were documented in men during a median 11.8 year follow-up.

Among women with diabetes, models that included HbA1c levels improved the C statistic (P<.001) over the risk equivalence model and benefited net reclassification improvement (NRI) by 26.7% (P=.001). Although also benefiting men, the improvements were found to be only modestly significant (C statistic change, P=.02; NRI, 9.2%; P=.04).

In secondary analyses, the researchers also found a consistent improvement in prediction for models using HbA1c vs. models using a dichotomous diabetes term in women (NRI, 11.8%; P=.03), but not in men.

“These results may be particularly helpful in light of current discussion around treatment choices for diabetic patients for prevention of CVD, including use of statins and aspirin,” the researchers wrote. “Our results suggest that the use of HbA1c levels as part of overall CVD risk scores may improve predictive ability in diabetic patients, whose HbA1c levels are routinely measured in clinical practice.”

Mark J. Pletcher, MD, MPH, with the University of California, commented in an accompanying editorial that even in spite of the study’s limitations, including the small diabetic population size and the use of coronary revascularization as an event, the ultimate findings are true.

In addition, “As guideline committees grapple with whether to endorse using HbA1c measurement for diabetic patients … they should also consider the more general issue of how to translate CVD risk discoveries more quickly into better population health,” he said. “Updating guidelines once per decade is not conducive, by itself, to rapid translation.”

Disclosures: Dr. Pletcher reports no relevant financial disclosures.

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