HbA1c is an independent predictor of non-fatal cardiovascular disease in a Caucasian population without diabetes: a 10-year follow-up of the Hoorn Study.

AIMS To investigate the associations of HbA1c, fasting glucose, and postload plasma glucose with 10-year fatal and non-fatal cardiovascular disease (CVD) and all-cause mortality in Caucasian individuals between 50 and 75 years of age without diabetes. METHOD AND RESULTS The 10-year risk of all-cause mortality and CVD in relation to HbA1cand glucose levels was assessed with Cox survival analysis in 1674 non-diabetic individuals of a population-based cohort (Hoorn Study). Analyses were stratified according to sex and adjustments were made for age and known CVD risk factors. After full adjustment, HbA1c levels ≥ 6.0% were significantly associated with an increased risk of non-fatal CVD compared with the lowest category of HbA1c (≤ 5.1%) in women [hazards ratio (HR) 2.27 (1.24-4.14)]. In addition, HbA1c as a continuous variable was significantly related to non-fatal CVD in both men [HR 1.40 (1.01-1.95)] and women [HR 2.41 (1.51-3.83)]. The relationships of HbA1 c with fatal CVD and all-cause mortality were explained by traditional CVD risk factors in both the sexes, along with the associations between fasting or postload plasma glucose and any of the outcome measures. CONCLUSION In Caucasian men and especially in women between 50 and 75 years of age who are without diabetes, high HbA1c levels are associated with increased risk of future non-fatal CVD, independent of other CVD risk factors.