增加HbA1c不能改善心血管风险评估

据3月25日在线发表于JAMA上的一项大型分析，在传统的心血管危险因素的基础上增加糖化血红蛋白(HbA1c)，在预测无糖尿病的中老年人群偶发性心血管病方面并无增益。

英国剑桥大学的Emanuele Di Angelantonio医生及其合作者指出，部分指南认为，在心血管风险预测模型中加入HbA1c等血糖指标可能有益，即使对于无糖尿病的患者也是如此。为确定HbA1c是否能改进心血管疾病的风险评估，他们分析了294,998名受试者的数据，这些受试者分别来自在20个国家的73项前瞻性队列研究，数据中记录了在中位时间10年的随访过程中发生的偶发性心血管事件。所有受试者均未患糖尿病；近86%居住在欧洲或北美，基线时的平均年龄为58岁。

结果显示，HbA1c与心血管风险间存在J形相关性，不过在统计学分析中，在心血管风险评估中加入HbA1c水平并未产生临床意义。HbA1c水平对区别是否发生心血管疾病并无助益。而在其他研究中，加入HbA1c值也没有改变受试者的风险级别。

本研究由英国心脏基金会、英国医学研究理事会、英国国家健康研究院和剑桥生物医学研究中心资助。Di Angelantonio医生报告称与前导医学网（Lead-Up Medical Network）、默克、约翰威利出版公司、爱思唯尔以及辉瑞存在往来，其合作者报告称与多家企业有联系。

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By: MARY ANN MOON, Cardiology News Digital Network

Adding hemoglobin A1c level to traditional cardiovascular risk factors doesn’t improve the prediction of incident cardiovascular disease among middle-age and older adults who don’t have diabetes, according to a large analysis published online March 25 in JAMA.

Some guidelines have suggested that it may be helpful to include information on glycemia measures such as HbA1c in models that predict CVD risk, even among patients who don’t have diabetes, said Dr. Emanuele Di Angelantonio of the University of Cambridge (U.K.) and his associates in the Emerging Risk Factors Collaboration.

To determine whether or not HbA1c would improve risk assessment for CVD, they analyzed data collected for 294,998 participants in 73 prospective cohort studies conducted in 20 countries, which recorded incident cardiovascular events during a median follow-up of 10 years. None of the study subjects had diabetes; approximately 86% lived in Europe or North America, and the mean age at baseline was 58 years.

There was a J-shaped association between HbA1c and CVD risk. However, in several different statistical analyses of the data, HbA1c levels did not add to CVD risk assessment in a clinically meaningful way. HbA1c levels did nothing to help distinguish participants who developed CVD from those who did not. And adding HbA1c values to other, traditional cardiovascular risk factors did not result in reclassification of study participants from one risk category to another, the investigators said (JAMA 2014 March 25 [doi:10.1001/jama.2014.1873]).

This study was funded by the British Heart Foundation, the U.K. Medical Research Council, the U.K. National Institute of Health Research, and the Cambridge Biomedical Research Centre. Dr. Di Angelantonio reported ties to Lead-Up Medical Network, Merck, John Wiley & Sons, Elsevier, and Pfizer; his associates reported ties to numerous industry sources.