An old test, but a new way to predict heart disease?

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As a rule, diabetic patients have a higher risk of cardiovascular disease. Now, the results of a study published in Archives of Internal Medicine suggest that a patient s blood level of glyco-hemoglobin (HbA1c, an indicator of long-term blood glucose control) might be a more precise indicator of that risk. What s more, if these study results are applicable, HbA1c level could also be used as a predictor of cardiovascular disease risk for non-diabetic patients.

The study authors, led by Dr. Nina P. Paynter of Brigham and Women s Hospital in Boston, analyzed data from nearly 25,000 women and over 11,000 men from, respectively, the Women s Health Study and the Physician s Health Study. Of the women, 685 were diabetic; of the men, 563 were. The groups were followed for about eleven years. By analyzing the effect of adding HbA1c to the 10-year risk estimates based on standard measures, the researchers found that they improved their prediction of risk in both diabetic women and men although the percentage improvement of about 25 percent in women was more significant than the modest 10 percent improvement in identifying risk in men.

While the authors recognize the limitation of the small number of diabetic patients in their study, they believe that their findings demonstrate the value of using HbA1c to more effectively determine which diabetic patients are at greater risk for cardiovascular disease, thus allowing for more tailored treatment choices. Although the use of HbA1c didn t improve either the prediction of risk in non-diabetic patients in this study, or the prediction of death in any patients, it did help distinguish between diabetic patients who were at high or lower risk of heart attacks.

While intrigued by the implications of the findings, ACSH's Dr. Gilbert Ross says he would like to see another study designed to examine how well the HbA1c criterion could serve as a predictor of cardiovascular events, in non-diabetics.