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Glycated haemoglobin A1c as a risk factor of cardiovascular outcomes and all-cause mortality in diabetic and non-diabetic populations: A systematic review and meta-analysis

dc.contributor.authorCavero-Redondo I.
dc.contributor.authorPeleteiro B.
dc.contributor.authorÁlvarez-Bueno C.
dc.contributor.authorRodriguez-Artalejo F.
dc.contributor.authorMartínez-Vizcaíno V.
dc.date.accessioned2020-09-02T22:14:59Z
dc.date.available2020-09-02T22:14:59Z
dc.date.issued2017
dc.identifier10.1136/bmjopen-2017-015949
dc.identifier.citation7, 7, -
dc.identifier.issn20446055
dc.identifier.urihttps://hdl.handle.net/20.500.12728/4059
dc.descriptionObjective To examine the relationship between glycated haemoglobin A1c (HbA1c) levels and the risk of cardiovascular outcomes and all-cause mortality based on data from observational studies and to determine the optimal levels of HbA1c for preventing cardiovascular events and/or mortality in diabetic and non-diabetic populations. Review methods We systematically searched Medline, Embase, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews and Web of Science databases, from inception to July 2016, for observational studies addressing the association of HbA1c levels with mortality and cardiovascular outcomes. Random effects models were used to compute pooled estimates of HR and respective 95% CI for all-cause mortality, cardiovascular mortality and risk of cardiovascular events, separately for people with and without diabetes. Results Seventy-four published studies were included in the systematic review, but only 46 studies could be incorporated in the meta-analysis. In both diabetic and non-diabetic populations, there was an increase in the risk of all-cause mortality when HbA1c levels were over 8.0% and 6.0%, respectively. The highest all-cause mortality in people with diabetes was HbA1c above 9.0% (HR=1.69; 95% CI 1.09 to 2.66) and in those without diabetes was HbA1c above 6.0% (HR=1.74; 95% CI 1.38 to 2.20). However, both diabetic and non-diabetic populations with lower HbA1c levels (below 6.0% HR=1.57; 95% CI 1.14 to 2.17 and below 5.0% HR=1.19; 95% CI 1.04 to 1.36, respectively) had higher all-cause mortality. Similar pooled estimates were found when cardiovascular mortality was the outcome variable. Conclusion HbA1c is a reliable risk factor of all-cause and cardiovascular mortality in both diabetics and non-diabetics. Our findings establish optimal HbA1c levels, for the lowest all-cause and cardiovascular mortality, ranging from 6.0% to 8.0% in people with diabetes and from 5.0% to 6.0% in those without diabetes. © 2017 author(s).
dc.language.isoen
dc.publisherBMJ Publishing Group
dc.subjectAll-cause mortality
dc.subjectCardiovascular mortality
dc.subjectHbA1c
dc.subjectMeta-analysis
dc.subjecthemoglobin A1c
dc.subjectglycosylated hemoglobin
dc.subjectArticle
dc.subjectcardiovascular mortality
dc.subjectcardiovascular risk
dc.subjectclinical outcome
dc.subjectCochrane Library
dc.subjectcontrolled clinical trial (topic)
dc.subjectdiabetes mellitus
dc.subjectdiabetic patient
dc.subjectEmbase
dc.subjecthuman
dc.subjectMedline
dc.subjectmeta analysis
dc.subjectobservational study
dc.subjectsystematic review
dc.subjectWeb of Science
dc.subjectblood
dc.subjectcardiovascular disease
dc.subjectmetabolism
dc.subjectmortality
dc.subjectnon insulin dependent diabetes mellitus
dc.subjectrisk factor
dc.subjectCardiovascular Diseases
dc.subjectDiabetes Mellitus, Type 2
dc.subjectGlycated Hemoglobin A
dc.subjectHumans
dc.subjectObservational Studies as Topic
dc.subjectRisk Factors
dc.titleGlycated haemoglobin A1c as a risk factor of cardiovascular outcomes and all-cause mortality in diabetic and non-diabetic populations: A systematic review and meta-analysis
dc.typeArticle


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