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dc.contributor.advisor
dc.contributor.advisor
dc.contributor.authorSchöttker, Ben
dc.contributor.authorRathmann, Wolfgang
dc.contributor.authorHerder, Christian
dc.contributor.authorThorand, Barbara
dc.contributor.authorWilsgaard, Tom
dc.contributor.authorNjølstad, Inger
dc.contributor.authorSiganos, Galatios
dc.contributor.authorMathiesen, Ellisiv B.
dc.contributor.authorSaum, Kai-Uwe
dc.contributor.authorPeasey, Anne
dc.contributor.authorFeskens, Edith J.M.
dc.contributor.authorBoffetta, Paolo
dc.contributor.authorTrichopoulou, Antonia
dc.contributor.authorKuulasmaa, Kari
dc.contributor.authorKee, Frank
dc.contributor.authorBrenner, Hermann
dc.date.accessioned2017-02-23T09:22:05Z
dc.date.available2017-02-23T09:22:05Z
dc.date.issued2016-02-11
dc.description.abstractBackground:<br>To determine the shape of the associations of HbA1c with mortality and cardiovascular outcomes in non-diabetic individuals and explore potential explanations.<br> Methods:<br> The associations of HbA1c with all-cause mortality, cardiovascular mortality and primary cardiovascular events (myocardial infarction or stroke) were assessed in non-diabetic subjects ≥50 years from six population-based cohort studies from Europe and the USA and meta-analyzed. Very low, low, intermediate and increased HbA1c were defined as <5.0, 5.0 to <5.5, 5.5 to <6.0 and 6.0 to <6.5 % (equals <31, 31 to <37, 37 to <42 and 42 to <48 mmol/mol), respectively, and low HbA1c was used as reference in Cox proportional hazards models.<br> Results:<br>Overall, 6,769 of 28,681 study participants died during a mean follow-up of 10.7 years, of whom 2,648 died of cardiovascular disease. Furthermore, 2,493 experienced a primary cardiovascular event. A linear association with primary cardiovascular events was observed. Adjustment for cardiovascular risk factors explained about 50 % of the excess risk and attenuated hazard ratios (95 % confidence interval) for increased HbA1c to 1.14 (1.03–1.27), 1.17 (1.00–1.37) and 1.19 (1.04–1.37) for all-cause mortality, cardiovascular mortality and cardiovascular events, respectively. The six cohorts yielded inconsistent results for the association of very low HbA1c levels with the mortality outcomes and the pooled effect estimates were not statistically significant. In one cohort with a pronounced J-shaped association of HbA1c levels with all-cause and cardiovascular mortality (NHANES), the following confounders of the association of very low HbA1c levels with mortality outcomes were identified: race/ethnicity; alcohol consumption; BMI; as well as biomarkers of iron deficiency anemia and liver function. Associations for very low HbA1c levels lost statistical significance in this cohort after adjusting for these confounders.<br>Conclusions:<br> A linear association of HbA1c levels with primary cardiovascular events was observed. For cardiovascular and all-cause mortality, the observed small effect sizes at both the lower and upper end of HbA1c distribution do not support the notion of a J-shaped association of HbA1c levels because a certain degree of residual confounding needs to be considered in the interpretation of the results.<br> Keywords:<br> Glycated hemoglobin, Cardiovascular disease, Myocardial infarction, Stroke, Mortality, Cohort study, Meta-analysisen_US
dc.description.sponsorshipThis analysis was part of the CHANCES project funded in the FP7 framework programme of DG-RESEARCH in the European Commission (grant no. 242244) and additional funding was obtained from the German Research Foundation (DFG; grant no. 616604). Further funding sources of participating cohorts are listed in the Additional file 1. (see <a href=http://dx.doi.org/10.1186/s12916-016-0570-1>doi: 10.1186/s12916-016-0570-1</a>)en_US
dc.descriptionSource: <a href=http://dx.doi.org/10.1186/s12916-016-0570-1>doi: 10.1186/s12916-016-0570-1</a>en_US
dc.identifier.citationSchöttker B, Rathmann W, Herder C, Thorand B, Wilsgaard T, Njølstad i, Siganos G, Mathiesen EB, Saum K, Peasey A, Feskens EJ, Boffetta P, Trichopoulou A, Kuulasmaa K, Kee F, Brenner H. HbA1c levels in non-diabetic older adults - No J-shaped associations with primary cardiovascular events, cardiovascular and all-cause mortality after adjustment for confoundersin a meta-analysis of individual participant data from six cohort studies. BMC Medicine. 2016;14:26:1-17en_US
dc.identifier.cristinIDFRIDAID 1419014
dc.identifier.doi10.1186/s12916-016-0570-1
dc.identifier.issn1741-7015
dc.identifier.urihttps://hdl.handle.net/10037/10347
dc.language.isoengen_US
dc.publisherBioMed Central
dc.relation.journalBMC Medicine
dc.rights.accessRightsopenAccessen_US
dc.subjectVDP::Medisinske Fag: 700::Helsefag: 800::Samfunnsmedisin, sosialmedisin: 801en_US
dc.subjectVDP::Medical disciplines: 700::Health sciences: 800::Community medicine, Social medicine: 801en_US
dc.titleHbA1c levels in non-diabetic older adults - No J-shaped associations with primary cardiovascular events, cardiovascular and all-cause mortality after adjustment for confoundersin a meta-analysis of individual participant data from six cohort studiesen_US
dc.typeJournal articleen_US
dc.typeTidsskriftartikkelen_US
dc.typePeer revieweden_US


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