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Comparative Study
. 2011 Oct 24;171(19):1712-8.
doi: 10.1001/archinternmed.2011.351. Epub 2011 Jul 25.

Cardiovascular Risk Prediction in Diabetic Men and Women Using Hemoglobin A1c vs Diabetes as a High-Risk Equivalent

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Comparative Study

Cardiovascular Risk Prediction in Diabetic Men and Women Using Hemoglobin A1c vs Diabetes as a High-Risk Equivalent

Nina P Paynter et al. Arch Intern Med. .
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Abstract

Background: It is unclear whether models that include hemoglobin A(1c) (HbA(1c)) levels only for diabetic patients improve the ability to predict cardiovascular disease (CVD) risk compared with the currently recommended classification of diabetes as a cardiovascular risk equivalent.

Methods: A total of 24 674 women (including 685 diabetic participants at baseline) and 11 280 men (including 563 diabetic participants at baseline) were followed up prospectively for cardiovascular disease (CVD). One hundred twenty-five CVD events occurred in diabetic women (666 in nondiabetic women), and 170 events occurred in diabetic men (1382 in nondiabetic men). Models for CVD risk were generated separately for men and women using the traditional CVD risk factors with the addition of a term for HbA(1c) levels only for diabetic individuals. In diabetic participants, the resulting predicted risks were compared with classification of diabetes as a cardiovascular risk equivalent (10-year CVD risk of at least 20%).

Results: In women, the models including HbA(1c) levels in diabetic participants improved the C statistic by 0.177 (P < .001) over the risk equivalence model and showed improved reclassification (net reclassification improvement [NRI] of 26.7% [P = .001]). In men, the improvements were more modest but still statistically significant (C statistic change of 0.039 [P = .02]; NRI of 9.2% [P = .04]). Including HbA(1c) levels also improved prediction over a dichotomous term for diabetes in women (NRI of 11.8% [P = .03]) but not in men.

Conclusions: In both women and men with diabetes at baseline, we observed significant improvements in predictive ability of CVD risk using models incorporating HbA(1c) levels compared with classification of diabetes as a cardiovascular risk equivalent.

Conflict of interest statement

Conflicts of Interest

Dr. Paynter reports receiving investigator initiated funding for this project from F. Hoffmann-La Roche, Ltd. Dr. Mazer reports employment by and stock ownership in F. Hoffmann-La Roche, Ltd. Dr. Ridker reports receiving investigator initiated funding from the Leducq Foundation, Roche Diagnostics, Amgen, Inc., AstraZeneca, Novartis, Merck, Abbott, and Sanofi-Aventis; consulting fees from AstraZeneca, Novartis, Merck–Schering-Plough, Sanofi-Aventis, Isis, Siemens, and Vascular Biogenics; and is listed as a coinventor on patents held by Brigham and Women’s Hospital that relate to the use of inflammatory biomarkers in cardiovascular disease, including the use of high-sensitivity C-reactive protein in the evaluation of patients’ risk of cardiovascular disease. These patents have been licensed to Siemens and AstraZeneca. The other authors report no conflicts of interest.

Figures

Figure 1
Figure 1
Distribution of Predicted 10-Year Cardiovascular Risk in Diabetic Participants from ATP III Models including HbA1c

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