title: Glycated haemoglobin, diabetes, and mortality in men in Norfolk cohort of european prospective investigation of cancer and nutrition (EPIC-Norfolk).
abstract: OBJECTIVE
  To examine the value of glycated haemoglobin (HbA(1c)) concentration, a marker of blood glucose concentration, as a predictor of death from cardiovascular and all causes in men.
  
  
  METHODS
  Prospective population study.
  
  
  METHODS
  Norfolk cohort of European Prospective Investigation into Cancer and Nutrition (EPIC-Norfolk).
  
  
  METHODS
  4662 men aged 45-79 years who had had glycated haemoglobin measured at the baseline survey in 1995-7 who were followed up to December 1999.
  
  
  METHODS
  Mortality from all causes, cardiovascular disease, ischaemic heart disease, and other causes.
  
  
  RESULTS
  Men with known diabetes had increased mortality from all causes, cardiovascular disease, and ischaemic disease (relative risks 2.2, 3.3, and 4.2, respectively, P <0.001 independent of age and other risk factors) compared with men without known diabetes. The increased risk of death among men with diabetes was largely explained by HbA(1c) concentration. HbA(1c) was continuously related to subsequent all cause, cardiovascular, and ischaemic heart disease mortality through the whole population distribution, with lowest rates in those with HbA(1c) concentrations below 5%. An increase of 1% in HbA(1c) was associated with a 28% (P<0.002) increase in risk of death independent of age, blood pressure, serum cholesterol, body mass index, and cigarette smoking habit; this effect remained (relative risk 1.46, P=0.05 adjusted for age and risk factors) after men with known diabetes, a HbA(1c) concentration >/=7%, or history of myocardial infarction or stroke were excluded. 18% of the population excess mortality risk associated with a HbA(1c) concentration >/=5% occurred in men with diabetes, but 82% occurred in men with concentrations of 5%-6.9% (the majority of the population).
  
  
  CONCLUSIONS
  Glycated haemoglobin concentration seems to explain most of the excess mortality risk of diabetes in men and to be a continuous risk factor through the whole population distribution. Preventive efforts need to consider not just those with established diabetes but whether it is possible to reduce the population distribution of HbA(1c) through behavioural means.
authors.affiliation: Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge CB2 2SR.
authors.forename: K T
authors.initials: KT
authors.lastname: Khaw
authors.forename: N
authors.initials: N
authors.lastname: Wareham
authors.forename: R
authors.initials: R
authors.lastname: Luben
authors.forename: S
authors.initials: S
authors.lastname: Bingham
authors.forename: S
authors.initials: S
authors.lastname: Oakes
authors.forename: A
authors.initials: A
authors.lastname: Welch
authors.forename: N
authors.initials: N
authors.lastname: Day
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood* / Q000150:complications / Q000401:mortality*; D002423:Cause of Death; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000097:blood* / Q000401:mortality*; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000097:blood / Q000150:complications / Q000401:mortality; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin