title: HbA1c and the risks for all-cause and cardiovascular mortality in the general Japanese population: NIPPON DATA90.
abstract: OBJECTIVE
  Associations between HbA1c and cardiovascular diseases (CVD) have been reported mainly in Western countries. It is not clear whether HbA1c measurements are useful for assessing CVD mortality risk in East Asian populations.
  
  
  METHODS
  The risk for cardiovascular death was evaluated in a large cohort of participants selected randomly from the overall Japanese population. A total of 7,120 participants (2,962 men and 4,158 women; mean age 52.3 years) free of previous CVD were followed for 15 years. Adjusted hazard ratios (HRs) and 95% CIs among categories of HbA1c (<5.0%, 5.0-5.4%, 5.5-5.9%, 6.0-6.4%, and ≥6.5%) for participants without treatment for diabetes and HRs for participants with diabetes were calculated using a Cox proportional hazards model.
  
  
  RESULTS
  During the study, there were 1,104 deaths, including 304 from CVD, 61 from coronary heart disease, and 127 from stroke (78 from cerebral infarction, 25 from cerebral hemorrhage, and 24 from unclassified stroke). Relations to HbA1c with all-cause mortality and CVD death were graded and continuous, and multivariate-adjusted HRs for CVD death in participants with HbA1c 6.0-6.4% and ≥6.5% were 2.18 (95% CI 1.22-3.87) and 2.75 (1.43-5.28), respectively, compared with participants with HbA1c <5.0%. Similar associations were observed between HbA1c and death from coronary heart disease and death from cerebral infarction.
  
  
  CONCLUSIONS
  High HbA1c levels were associated with increased risk for all-cause mortality and death from CVD, coronary heart disease, and cerebral infarction in general East Asian populations, as in Western populations.
authors.affiliation: Corresponding author: Masaru Sakurai, m-sakura@kanazawa-med.ac.jp.
authors.forename: Masaru
authors.initials: M
authors.lastname: Sakurai
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Saitoh
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Miura
authors.forename: Hideaki
authors.initials: H
authors.lastname: Nakagawa
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Ohnishi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Akasaka
authors.forename: Aya
authors.initials: A
authors.lastname: Kadota
authors.forename: Yoshikuni
authors.initials: Y
authors.lastname: Kita
authors.forename: Takehito
authors.initials: T
authors.lastname: Hayakawa
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Ohkubo
authors.forename: Akira
authors.initials: A
authors.lastname: Okayama
authors.forename: Tomonori
authors.initials: T
authors.lastname: Okamura
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Ueshima
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People; D002318:Cardiovascular Diseases / Q000097:blood / Q000401:mortality*; D003327:Coronary Disease / Q000401:mortality; D003920:Diabetes Mellitus / Q000401:mortality; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012306:Risk; D020521:Stroke / Q000401:mortality
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human