Association of HbA1c and cardiovascular and renal disease in an adult Mediterranean population.

BACKGROUND: Increasing evidence suggests a mechanistic link between the glycemic environment and renal and cardiovascular events, even below the threshold for diabetes. We aimed to assess the association between HbA1c and chronic kidney disease (CKD) and cardiovascular disease (CVD). METHODS: A cross-sectional study involving a random representative sample of 2270 adults from southern Spain (Malaga) was undertaken. We measured HbA1c, serum creatinine and albuminuria in fasting blood and urine samples. RESULTS: Individuals without diabetes in the upper HbA1c tertile had an unfavorable cardiovascular and renal profile and shared certain clinical characteristics with the patients with diabetes. Overall, a higher HbA1c concentration was strongly associated with CKD or CVD after adjustment for traditional risk factors. The patients with known diabetes had a 2-fold higher odds of CKD or CVD. However, when both parameters were introduced in the same model, the HbA1c concentration was only significantly associated with clinical endpoints (OR: 1.4, 95% CI, 1.1-1.6, P = 0.002). An increase in HbA1c of one percentage point was associated with a 30% to 40% increase in the rate of CKD or CVD. This relationship was apparent in persons with and without known diabetes. ROC curves illustrated that a HbA1c of 37 mmol/mol (5.5%) was the optimal value in terms of sensitivity and specificity for predicting endpoints in this population. CONCLUSION: HbA1c levels were associated with a higher prevalence of CKD and CVD cross-sectionally, regardless of diabetes status. These data support the value of HbA1c as a marker of cardiovascular and renal disease in the general population.

Educational inequalities and cardiovascular risk factors. A cross-sectional population-based study in southern Spain.

OBJECTIVES: To determine the prevalence and distribution of modifiable cardiovascular risk factors focused on educational level differences, in an adult population in Southern Spain. DESIGN AND SAMPLE: Cross-sectional population-based study. Random sample from the adult population assigned to a Primary Health Care Centre in Málaga (Southern Spain), which attends 38,625 inhabitants. MEASURES: Level of education, physical activity, blood pressure, waist perimeter, body mass index, lipid profile, fasting plasma glucose, among others, were assessed. RESULTS: Final sample included 2,270 subjects with a mean age of 43.65 (SD: 16.65), 49.74% male and 50.26% female. 57.6% had none or only primary studies. Overweight was present in 55.8%, smokers were 27.6% and sedentary people 51.9%. Once adjusted by sex and age, all modifiable factors were lower in people with higher education. The highest risks were sedentarism (OR 1.95; 95% CI: 1.16-3.29) and hypertension (OR: 2.07 95% CI: 1.49-2.80) for those with lower education. CONCLUSIONS: There is a clear inverse gradient of cardiovascular risk factors and educational level in the study population. Public health and community nurses should develop strong interventions for this challenge and extend their influence to public policies focused on educational inequalities and health.

Why not use the HbA1c as a criterion of dysglycemia in the new definition of the metabolic syndrome? Impact of the new criteria in the prevalence of the metabolic syndrome in a Mediterranean urban population from Southern Europe (IMAP study. Multidisciplinary intervention in primary care).

We analysed the prevalence of metabolic syndrome (MS) of the new diagnostic criteria and the HbA1c to diagnose dysglycemia. We studied 2006 adults without cardiovascular disease or diabetes. The use of the new criteria and the HbA1c resulted in an increase in the population prevalence of MS.