title: The association of hemoglobin a1c with incident heart failure among people without diabetes: the atherosclerosis risk in communities study.
abstract: OBJECTIVE
  This study sought to investigate an association of HbA1c (A1C) with incident heart failure among individuals without diabetes and compare it to fasting glucose.
  
  
  METHODS
  We studied 11,057 participants of the Atherosclerosis Risk in Communities (ARIC) Study without heart failure or diabetes at baseline and estimated hazard ratios of incident heart failure by categories of A1C (<5.0, 5.0-5.4 [reference], 5.5-5.9, and 6.0-6.4%) and fasting glucose (<90, 90-99 [reference], 100-109, and 110-125 mg/dl) using Cox proportional hazards models.
  
  
  RESULTS
  A total of 841 cases of incident heart failure hospitalization or deaths (International Classification of Disease, 9th/10th Revision, 428/I50) occurred during a median follow-up of 14.1 years (incidence rate 5.7 per 1,000 person-years). After the adjustment for covariates including fasting glucose, the hazard ratio of incident heart failure was higher in individuals with A1C 6.0-6.4% (1.40 [95% CI, 1.09-1.79]) and 5.5-6.0% (1.16 [0.98-1.37]) as compared with the reference group. Similar results were observed when adjusting for insulin level or limiting to heart failure cases without preceding coronary events or developed diabetes during follow-up. In contrast, elevated fasting glucose was not associated with heart failure after adjustment for covariates and A1C. Similar findings were observed when the top quartile (A1C, 5.7-6.4%, and fasting glucose, 108-125 mg/dl) was compared with the lowest quartile (<5.2% and <95 mg/dl, respectively).
  
  
  CONCLUSIONS
  Elevated A1C (> or =5.5-6.0%) was associated with incident heart failure in a middle-aged population without diabetes, suggesting that chronic hyperglycemia prior to the development of diabetes contributes to development of heart failure.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. kmatsush@jhsph.edu
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Matsushita
authors.forename: Saul
authors.initials: S
authors.lastname: Blecker
authors.forename: Antonio
authors.initials: A
authors.lastname: Pazin-Filho
authors.forename: Alain
authors.initials: A
authors.lastname: Bertoni
authors.forename: Patricia P
authors.initials: PP
authors.lastname: Chang
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Selvin
mesh_terms: D050197:Atherosclerosis / Q000097:blood / Q000453:epidemiology*; D001786:Blood Glucose / Q000032:analysis; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology; D004522:Educational Status; D005215:Fasting; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006333:Heart Failure / Q000097:blood*; D006801:Humans; D007328:Insulin / Q000097:blood; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012016:Reference Values; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin