Low Hemoglobin A^sub 1c^ in Nondiabetic Adults: An elevated risk state?

• Autores: Vikas Aggarwal, Andrea L.C. Schneider, Elizabeth Selvin
• Localización: Diabetes care, ISSN-e 0149-5992, Vol. 35, Nº. 10, 2012, págs. 2055-2060
• Idioma: inglés
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• Resumen

  • To identify predictors of low hemoglobin A^sub 1c^ (HbA^sub 1c^) (<5.0%) and to investigate the association of low HbA^sub 1c^ with cause-specific mortality and risk of liver disease hospitalization. Prospective cohort study of 13,288 participants in the Atherosclerosis Risk in Communities Study. Logistic regression was used to identify cross-sectional correlates of low HbA^sub 1c^ and Cox proportional hazards models were used to estimate the association of low HbA^sub 1c^ with cause-specific mortality. Compared with participants with HbA^sub 1c^ in the normal range (5.0 to <5.7%), participants with low HbA^sub 1c^ were younger, less likely to smoke, had lower BMI, lower white cell count and fibrinogen levels, and lower prevalence of hypercholesterolemia and history of coronary heart disease. However, this group was more likely to have anemia and had a higher mean corpuscular volume. In adjusted Cox models with HbA^sub 1c^ of 5.0 to <5.7% as the reference group, HbA^sub 1c^ <5.0% was associated with a significantly increased risk of all-cause mortality (hazard ratio [HR]: 1.32, 95% CI: 1.13-1.55) and of cancer death (1.47, 95% CI: 1.16-1.84). We also noted nonsignificant trends toward increased risk of death from cardiovascular causes (1.27, 95% CI: 0.93-1.75) and respiratory causes (1.42, 95% CI: 0.78-2.56). There was a J-shaped association between HbA^sub 1c^ and risk of liver disease hospitalization. No single cause of death appeared to drive the association between low HbA^sub 1c^ and total mortality. These results add to evidence that low HbA^sub 1c^ values may be a generalized marker of mortality risk in the general population.