Fructosamine and Glycated Albumin and the Risk of Cardiovascular Outcomes and Death

Circulation. 2015 Jul 28;132(4):269-77. doi: 10.1161/CIRCULATIONAHA.115.015415. Epub 2015 May 28.


Background: Hemoglobin A1c (HbA1c) is the standard measure to monitor glucose control in diabetes mellitus and is a marker of future cardiovascular risk. Fructosamine and glycated albumin are markers of short-term glycemic control, but their associations with cardiovascular outcomes are uncharacterized.

Methods and results: We measured glycated albumin and fructosamine in 11 104 participants with and without diabetes in the community-based Atherosclerosis Risk in Communities (ARIC) Study in 1990 to 1992 (baseline). We evaluated associations of fructosamine and glycated albumin with risk of coronary heart disease, ischemic stroke, heart failure, and mortality. We compared associations with those observed for HbA1c. During two decades of follow-up there were 1096 new cases of coronary heart disease, 605 of ischemic stroke, 1432 of heart failure, and 2860 deaths. Elevated baseline concentrations of fructosamine and glycated albumin were significantly associated with each of the outcomes even after adjustment for traditional cardiovascular risk factors, with especially strong associations in persons with diabetes mellitus. Associations were of similar magnitude to those observed for HbA1c and-as has been previously observed for HbA1c-the associations tended to be J-shaped, with an elevation of risk at the lowest levels of each biomarker.

Conclusions: The acceptance of new measures of hyperglycemia is partly dependent on establishing their association with long-term outcomes. We found that fructosamine and glycated albumin were associated with vascular outcomes and mortality and that these associations were similar to those observed for HbA1c.

Keywords: biomarkers; cardiovascular disease; diabetes mellitus; epidemiology; fructosamine; glycated albumin; hyperglycemia; mortality.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Biomarkers / blood
  • Coronary Disease / blood
  • Coronary Disease / epidemiology*
  • Coronary Disease / mortality
  • Diabetes Complications / blood
  • Diabetes Complications / complications
  • Female
  • Fructosamine / blood*
  • Glycated Hemoglobin A / metabolism
  • Heart Failure / blood
  • Heart Failure / epidemiology*
  • Heart Failure / mortality
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • Serum Albumin / metabolism*
  • Stroke / blood
  • Stroke / epidemiology*
  • Stroke / mortality
  • Survival Rate


  • Biomarkers
  • Glycated Hemoglobin A
  • Serum Albumin
  • glycated serum albumin
  • Fructosamine