This study sought to compare the relationships between values of glycated hemoglobin and fasting glucose and the risk of diabetes, coronary heart disease, ischemic stroke, and death from any cause. The study cohort included 11,092 black or white adults with no history of diabetes or cardiovascular disease from the Atherosclerosis Risk in Communities (ARIC) study. The results showed that people with a glycated hemoglobin value of 6.0% or higher are at increased risk for the development of diabetes, even after adjustment for other risk factors and independently of baseline fasting glucose levels. It was also observed that glycated hemoglobin was a marker of cardiovascular risk even after controlling for fasting glucose levels. In contrast, the association between fasting glucose levels and the risk of cardiovascular disease or death from any cause was no longer significant after adjusting for glycated hemoglobin value. Moreover, results showed improved risk reclassification for coronary heart disease with the inclusion of glycated hemoglobin in fully adjusted models. These findings suggest that glycated hemoglobin is associated with risk of diabetes and is superior to fasting glucose for assessment of the long-term risk of subsequent cardiovascular disease.
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