title: Prediction by Low Plasma HbA1c of Mortality, Cardiac and Noncardiac Disease Risk: Modulation by Diabetic Status and Sex.
abstract: OBJECTIVE
  The aim of the study was to evaluate the predictive value of HbA(1c) for risk of overall mortality or a composite endpoint of death and nonfatal events.
  
  
  METHODS
  Logistic regression retrospectively assessed the longitudinal association of measured HbA(1c) with outcome in 746 middle-aged adults, recruited from a tertiary health center and stratified to absence or presence of type 2 diabetes, using the recent American Diabetes Association criteria.
  
  
  RESULTS
  A total of 70 deaths and additional incident nonfatal events in 82 cases were recorded at a median of 3.1-year follow-up. Multivariable linear regression revealed among nondiabetic individuals HbA(1c) to be significantly associated--independent of fasted glucose--inversely with triglycerides and high-density lipoprotein cholesterol, distinct from the diabetic sample. Sex and diabetes status differed in baseline HbA1c values with respect to the development of outcome. Nondiabetic men who subsequently died exhibited significantly lower HbA(1c), as did men and women with incident coronary heart disease. Similar difference was observed for incident hypothyroidism and nondiabetic subjects developing malignancy. In logistic regression analysis, adjusted for sex, age, and fasting glucose, each 0.7% (SD, 1) decrement of baseline HbA(1c) predicted the composite endpoint in the nondiabetic sample (risk estimates, 1.49%; 95% confidence interval, 1.07-2.04), but not in the diabetic sample, whereas overall mortality in the whole sample was increased (risk estimates, 1.51%; 95% confidence interval, 1.05-2.17).
  
  
  CONCLUSIONS
  Inverse association of HbA(1c) with adverse outcomes in men and nondiabetic people indicates the involvement of HbA(1c) levels in autoimmune activation. The weaker inverse association with prevalent diabetes and in women is consistent with the operation of more pronounced confounding autoimmune processes.
authors.affiliation: From the *Department of Cardiology, Edirne State Hospital, Edirne; Departments of †Cardiology and ‡Public Health, Cerrahpaşa Medical Faculty, Istanbul University; §Department of Internal Medicine, Haseki Training and Research Hospital; and ∥Cardiology Section, Siyami Ersek Center for Cardiovascular Surgery, Istanbul, Turkey.
authors.forename: Servet
authors.initials: S
authors.lastname: Altay
authors.forename: Altan
authors.initials: A
authors.lastname: Onat
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Karadeniz
authors.forename: Fatma
authors.initials: F
authors.lastname: Özpamuk-Karadeniz
authors.forename: Günay
authors.initials: G
authors.lastname: Can
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000097:blood* / Q000401:mortality*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000401:mortality*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D012727:Sex Characteristics
chemical_list: D006442:Glycated Hemoglobin