title: Better risk assessment with glycated hemoglobin instead of cholesterol in CVD risk prediction charts.
abstract: Traditional risk charts for the prediction of cardiovascular disease (CVD) include cholesterol parameters. We evaluated how models predict fatal CVD when cholesterol is replaced by glucose parameters. We used data from NHANES III, a US survey conducted 1988-1994 (follow-up until 2006); 15,454 participants (1,716 CVD deaths) were included. Based on the ESC SCORE method, we used age, sex, blood pressure, smoking and either of the following: (1) total cholesterol, (2) total-to-HDL-cholesterol, (3) glucose, (4) glycated hemoglobin (A1C). Scaled Brier score (BS), Nagelkerke's R(2) (NR) and integrated discrimination improvement (IDI) were used for model comparison. The ranking (best to worst) was: A1C (BS = 11.62 %; NR = 0.0865; IDI = 0.0091), glucose (11.16 %; 0.0734; 0.0067), total-to-HDL-cholesterol (9.97 %; 0.0547; 0.0010), cholesterol (9.75 %; 0.0484; 0, reference). Differences between models with cholesterol and glucose or A1C were statistically significant. This study suggests the use of A1C instead of cholesterol parameters in charts to assess CVD risk.
authors.affiliation: Institute of Social and Preventive Medicine (ISPM), University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland. david.faeh@uzh.ch
authors.forename: David
authors.initials: D
authors.lastname: Faeh
authors.forename: Sabine
authors.initials: S
authors.lastname: Rohrmann
authors.forename: Julia
authors.initials: J
authors.lastname: Braun
mesh_terms: D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000097:blood* / Q000453:epidemiology; D002784:Cholesterol / Q000097:blood*; D008076:Cholesterol, HDL / Q000097:blood; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D009026:Mortality; D009749:Nutrition Surveys; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012907:Smoking; D015996:Survival Rate; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D002784:Cholesterol; D008076:Cholesterol, HDL; D006442:Glycated Hemoglobin