title: A Test in Context: Hemoglobin A1cand Cardiovascular Disease.
abstract: Measurement of glycated hemoglobin (HbA1c), the most widely accepted indicator of long-term glycemic exposure, is central for the diagnosis and management of diabetes mellitus. Levels of HbA1ctrack epidemiologically with diabetic complications, and glycemic control, as reflected by HbA1creduction, results in decreased risk of microvascular complications, including diabetic kidney disease, neuropathy, and retinopathy. The relationship between HbA1creduction and cardiovascular disease prevention in patients with diabetes is more complex, with data from large randomized trials published over the past decade providing clear evidence that lowering of HbA1cper se is an inadequate marker for a therapeutic regimen's impact on cardiovascular outcomes and patient survival. Recent revisions in professional society guidelines moved away from uniform recommendations and toward a more nuanced, patient-centered approach to HbA1ctherapeutic targets. The context and key evidence underpinning these recent changes are discussed in this paper, alongside a brief overview of HbA1ccontemporary assays and their limitations.
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: maria.gore@utsouthwestern.edu.
authors.forename: M Odette
authors.initials: MO
authors.lastname: Gore
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Darren K
authors.initials: DK
authors.lastname: McGuire
mesh_terms: D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications*; D006442:Glycated Hemoglobin / Q000378:metabolism*; D038321:Glycemic Index; D006801:Humans
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin
keywords: diabetes mellitus; macrovascular complications; prevention