title: Association of HbA1c and cardiovascular and renal disease in an adult Mediterranean population.
abstract: BACKGROUND
  Increasing evidence suggests a mechanistic link between the glycemic environment and renal and cardiovascular events, even below the threshold for diabetes. We aimed to assess the association between HbA1c and chronic kidney disease (CKD) and cardiovascular disease (CVD).
  
  
  METHODS
  A cross-sectional study involving a random representative sample of 2270 adults from southern Spain (Malaga) was undertaken. We measured HbA1c, serum creatinine and albuminuria in fasting blood and urine samples.
  
  
  RESULTS
  Individuals without diabetes in the upper HbA1c tertile had an unfavorable cardiovascular and renal profile and shared certain clinical characteristics with the patients with diabetes. Overall, a higher HbA1c concentration was strongly associated with CKD or CVD after adjustment for traditional risk factors. The patients with known diabetes had a 2-fold higher odds of CKD or CVD. However, when both parameters were introduced in the same model, the HbA1c concentration was only significantly associated with clinical endpoints (OR: 1.4, 95% CI, 1.1-1.6, P = 0.002). An increase in HbA1c of one percentage point was associated with a 30% to 40% increase in the rate of CKD or CVD. This relationship was apparent in persons with and without known diabetes. ROC curves illustrated that a HbA1c of 37 mmol/mol (5.5%) was the optimal value in terms of sensitivity and specificity for predicting endpoints in this population.
  
  
  CONCLUSIONS
  HbA1c levels were associated with a higher prevalence of CKD and CVD cross-sectionally, regardless of diabetes status. These data support the value of HbA1c as a marker of cardiovascular and renal disease in the general population.
authors.forename: Domingo
authors.initials: D
authors.lastname: Hernandez
authors.forename: Ana
authors.initials: A
authors.lastname: Espejo-Gil
authors.forename: M Rosa
authors.initials: MR
authors.lastname: Bernal-Lopez
authors.forename: Jose
authors.initials: J
authors.lastname: Mancera-Romero
authors.forename: Antonio J
authors.initials: AJ
authors.lastname: Baca-Osorio
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Tinahones
authors.forename: Ana M
authors.initials: AM
authors.lastname: Armas-Padron
authors.forename: Pedro
authors.initials: P
authors.lastname: Ruiz-Esteban
authors.forename: Armando
authors.initials: A
authors.lastname: Torres
authors.forename: Ricardo
authors.initials: R
authors.lastname: Gomez-Huelgas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007674:Kidney Diseases / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D019083:Mediterranean Region / Q000453:epidemiology; D008875:Middle Aged; D013030:Spain / Q000453:epidemiology; D055815:Young Adult
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human