A Test in Context: Hemoglobin A1c and Cardiovascular Disease

M. Odette Gore, Darren K. McGuire

Research output: Contribution to journalReview article

7 Scopus citations

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 HbA1c track epidemiologically with diabetic complications, and glycemic control, as reflected by HbA1c reduction, results in decreased risk of microvascular complications, including diabetic kidney disease, neuropathy, and retinopathy. The relationship between HbA1c reduction 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 HbA1c per 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 HbA1c therapeutic targets. The context and key evidence underpinning these recent changes are discussed in this paper, alongside a brief overview of HbA1c contemporary assays and their limitations.

Original languageEnglish (US)
Pages (from-to)2479-2486
Number of pages8
JournalJournal of the American College of Cardiology
Volume68
Issue number22
DOIs
StatePublished - Dec 6 2016

Keywords

  • diabetes mellitus
  • macrovascular complications
  • prevention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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