title: Glycated hemoglobin and long-term prognosis in patients with suspected stable angina pectoris without diabetes mellitus: a prospective cohort study.
abstract: OBJECTIVE
  Associations of glycated hemoglobin A1c (HbA1c) levels to incident coronary and cardiovascular events among non-diabetic patients with coronary artery disease are unclear. We investigated relations of HbA1c to long-term prognosis in such patients.
  
  
  METHODS
  A prospective cohort of 2519 patients undergoing elective coronary angiography for suspected stable angina pectoris (SAP) was divided into pre-defined categories according to HbA1c (%) levels (<5.0, 5.0-5.6 (reference), 5.7-6.4), and followed for median 4.9 years. The primary end-point was major coronary events (including non-fatal and fatal acute myocardial infarctions, and sudden cardiac death). Secondary end-points were death from cardiovascular disease (CVD) and all-cause mortality. Hazard ratios (HRs) (95% confidence intervals [CIs]) were obtained by Cox regression.
  
  
  RESULTS
  Median age at inclusion was 62 years, 73% were males, median HbA1c was 5.6% and random plasma-glucose 5.4 mmol/L. After multivariate adjustment, HbA1c levels within the pre-diabetic range were not associated with risk of major coronary events, HR (95% CI): 1.13 (0.79-1.62); P=0.49, death from CVD or all-cause mortality HR (95% CI): 0.95 (0.55-1.66) and 1.04 (0.70-1.53), respectively; P≥0.85. Similarly, there was no significant association between HbA1c values within the lowest category and risk of study outcomes, (P≥0.18).
  
  
  CONCLUSIONS
  In non-diabetic patients with suspected SAP, there was no overall association between HbA1c levels and prognosis, questioning an independent role of glycemia in the pathogenesis of atherosclerotic complications in these patients.
authors.affiliation: Department of Heart Disease, Haukeland University Hospital, 5021 Bergen, Norway; Department of Clinical Science, University of Bergen, Mailbox 7804, 5021 Bergen, Norway. Electronic address: eirik.rebnord@gmail.com.
authors.forename: Eirik Wilberg
authors.initials: EW
authors.lastname: Rebnord
authors.affiliation: Department of Clinical Science, University of Bergen, Mailbox 7804, 5021 Bergen, Norway. Electronic address: eva.pedersen@k2.uib.no.
authors.forename: Eva Ringdal
authors.initials: ER
authors.lastname: Pedersen
authors.affiliation: Department of Clinical Science, University of Bergen, Mailbox 7804, 5021 Bergen, Norway. Electronic address: elin.strand@k2.uib.no.
authors.forename: Elin
authors.initials: E
authors.lastname: Strand
authors.affiliation: Department of Clinical Science, University of Bergen, Mailbox 7804, 5021 Bergen, Norway. Electronic address: gard.frodahl.tveitevag.svingen@helse-bergen.no.
authors.forename: Gard Frodahl Tveitevåg
authors.initials: GF
authors.lastname: Svingen
authors.affiliation: BEVITAL, Laboratoriebygget, 9th Floor, Jonas Lies veg 87, 5021 Bergen, Norway. Electronic address: klaus.meyer@farm.uib.no.
authors.forename: Klaus
authors.initials: K
authors.lastname: Meyer
authors.affiliation: Department of Heart Disease, Haukeland University Hospital, 5021 Bergen, Norway. Electronic address: hall.schartum-hansen@helse-bergen.no.
authors.forename: Hall
authors.initials: H
authors.lastname: Schartum-Hansen
authors.affiliation: Department of Clinical Science, University of Bergen, Mailbox 7804, 5021 Bergen, Norway. Electronic address: kjetil.loland@gmail.com.
authors.forename: Kjetil Halvorsen
authors.initials: KH
authors.lastname: Løland
authors.affiliation: Department of Clinical Science, University of Bergen, Mailbox 7804, 5021 Bergen, Norway. Electronic address: reinhard.seifert@helse-bergen.no.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Seifert
authors.affiliation: Department of Clinical Science, University of Bergen, Mailbox 7804, 5021 Bergen, Norway; Laboratory of Clinical Biochemistry, Haukeland University Hospital, 5021 Bergen, Norway. Electronic address: per.ueland@ikb.uib.no.
authors.forename: Per Magne
authors.initials: PM
authors.lastname: Ueland
authors.affiliation: Department of Clinical Science, University of Bergen, Mailbox 7804, 5021 Bergen, Norway; Division of Cardiology, Stavanger University Hospital, 4011 Stavanger, Norway. Electronic address: dnilsen1@getmail.no.
authors.forename: Dennis W T
authors.initials: DW
authors.lastname: Nilsen
authors.affiliation: Department of Clinical Science, University of Bergen, Mailbox 7804, 5021 Bergen, Norway; Division of Cardiology, Stavanger University Hospital, 4011 Stavanger, Norway. Electronic address: jan.nordrehaug@k2.uib.no.
authors.forename: Jan Erik
authors.initials: JE
authors.lastname: Nordrehaug
authors.affiliation: Department of Heart Disease, Haukeland University Hospital, 5021 Bergen, Norway; Department of Clinical Science, University of Bergen, Mailbox 7804, 5021 Bergen, Norway; K. G. Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, Mailbox 7804, 5021 Bergen, Norway. Electronic address: ottar.kjell.nygard@helse-bergen.no.
authors.forename: Ottar
authors.initials: O
authors.lastname: Nygård
mesh_terms: D000368:Aged; D060050:Angina, Stable / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Coronary artery disease; Glycated; HbA1c; Hemoglobin A; Mortality; Myocardial infarction; Pre-diabetes