TY - JOUR
T1 - No racial differences in the association of glycated hemoglobin with kidney disease and cardiovascular outcomes
AU - Selvin, Elizabeth
AU - Rawlings, Andreea M.
AU - Bergenstal, Richard M.
AU - Coresh, Josef
AU - Brancati, Frederick L.
PY - 2013/10
Y1 - 2013/10
N2 - OBJECTIVE There is debate regarding the clinical significance of well-established racial differences in HbA1c. We compared the associations of diabetes diagnostic categories for HbA1c and fasting glucose with clinical outcomes in black and white persons in the community. RESEARCH DESIGNANDMETHODSdWe conducted a prospective cohort analysis of participants without diabetes or cardiovascular disease from the Atherosclerosis Risk in Communities study.We examined the associations of clinical categories of HbA1c (≤5.7%, 5.7-6.4%, ≤6.5%) and fasting glucose (,100, 100-125, ≤126 mg/dL) with outcomes separately among 2,484 black and 8,593 white participants and tested for race interactions. RESULTSdBaseline characteristics differed significantly in blacks compared with whites, including HbA1c (5.8 vs. 5.4%; P , 0.001). During 18 years of follow-up, there were trends of increased risk of kidney disease, fatal and nonfatal coronary heart disease, and stroke across categories of HbA1c in both blacks and whites. The adjusted hazard ratios for each outcome across categories of HbA1c were similar in blacks and whites (P for interaction .0.05) except for all-cause mortality. Patterns of association were similar, but weaker, for fasting glucose. HbA1c and fasting glucose both were more strongly associated with all-cause mortality in whites compared with blacks, largely explained by racial differences in the rate of cardiovascular deaths. CONCLUSIONSdHbA 1c is a risk factor for vascular outcomes and mortality in both black and white adults. Patterns of association for HbA1c were similar to or stronger than those for fasting glucose. With respect to long-term outcomes, our findings support a similar interpretation of HbA1c in blacks and whites for diagnosis and treatment of diabetes mellitus.
AB - OBJECTIVE There is debate regarding the clinical significance of well-established racial differences in HbA1c. We compared the associations of diabetes diagnostic categories for HbA1c and fasting glucose with clinical outcomes in black and white persons in the community. RESEARCH DESIGNANDMETHODSdWe conducted a prospective cohort analysis of participants without diabetes or cardiovascular disease from the Atherosclerosis Risk in Communities study.We examined the associations of clinical categories of HbA1c (≤5.7%, 5.7-6.4%, ≤6.5%) and fasting glucose (,100, 100-125, ≤126 mg/dL) with outcomes separately among 2,484 black and 8,593 white participants and tested for race interactions. RESULTSdBaseline characteristics differed significantly in blacks compared with whites, including HbA1c (5.8 vs. 5.4%; P , 0.001). During 18 years of follow-up, there were trends of increased risk of kidney disease, fatal and nonfatal coronary heart disease, and stroke across categories of HbA1c in both blacks and whites. The adjusted hazard ratios for each outcome across categories of HbA1c were similar in blacks and whites (P for interaction .0.05) except for all-cause mortality. Patterns of association were similar, but weaker, for fasting glucose. HbA1c and fasting glucose both were more strongly associated with all-cause mortality in whites compared with blacks, largely explained by racial differences in the rate of cardiovascular deaths. CONCLUSIONSdHbA 1c is a risk factor for vascular outcomes and mortality in both black and white adults. Patterns of association for HbA1c were similar to or stronger than those for fasting glucose. With respect to long-term outcomes, our findings support a similar interpretation of HbA1c in blacks and whites for diagnosis and treatment of diabetes mellitus.
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U2 - 10.2337/dc12-2715
DO - 10.2337/dc12-2715
M3 - Article
C2 - 23723353
AN - SCOPUS:84891865427
SN - 0149-5992
VL - 36
SP - 2995
EP - 3001
JO - Diabetes care
JF - Diabetes care
IS - 10
ER -