Dysglycaemia and the risk of acute myocardial infarction in multiple ethnic groups: an analysis of 15,780 patients from the INTERHEART study.
OBJECTIVE
Although diabetes is an established risk factor for myocardial infarction (MI), disease control may vary. HbA(1c) is a reliable index of ambient glucose levels and may provide more information on MI risk than diabetes status.


METHODS
The relationship between HbA(1c) levels in MI patients and controls who participated in the 52 country INTERHEART study was analysed.


RESULTS
In 15,780 participants with a HbA(1c) value (1,993 of whom had diabetes), the mean (SD) levels for HbA(1c) were 6.15% (1.10) in the 6,761 MI patients and 5.85% (0.80) in the control participants. After adjustment for age, sex and nine major MI risk factors (including diabetes), higher HbA(1c) fifths above the lowest fifth (HbA(1c) <5.4%) were associated with progressively higher OR of MI, with OR for the highest HbA(1c) fifth (≥ 6.12%) being 1.55 (95% CI 1.37-1.75). When analysed as a continuous variable after adjustment for the same factors, every 1% higher HbA(1c) value was associated with 19% (95% CI 14-23) higher odds of MI, while every 0.5% higher HbA(1c) was associated with 9% higher odds of MI (95% CI 7-11). Concordant relationships were noted across subgroups, with a higher OR noted in younger people, patients without diabetes or hypertension, and those from some regions and ethnicities.


CONCLUSIONS
The HbA(1c) value provides more information on MI odds than self-reported diabetes status or many other established risk factors. Every 1% increment independently predicts a 19% higher odds of MI after accounting for other MI risk factors including diabetes.
Gerstein
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HC
The Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada. gerstein@mcmaster.ca
Islam
S
S
Anand
S
S
Almahmeed
W
W
Damasceno
A
A
Dans
A
A
Lang
C C
CC
Luna
M A
MA
McQueen
M
M
Rangarajan
S
S
Rosengren
A
A
Wang
X
X
Yusuf
S
S
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D016022:Case-Control Studies; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D044882:Glucose Metabolism Disorders / Q000097:blood / Q000150:complications* / Q000453:epidemiology / Q000208:ethnology*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000453:epidemiology / Q000208:ethnology* / Q000209:etiology*; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors
D015415:Biomarkers; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human