A Test in Context Hemoglobin A1c and Cardiovascular Disease

[摘要] Measurement of glycated hemoglobin (HbA(1c)), the most widely accepted indicator of long-term glycemic exposure, is central for the diagnosis and management of diabetes mellitus. Levels of HbA(1c) track epidemiologically with diabetic complications, and glycemic control, as reflected by HbA(1c) reduction, results in decreased risk of microvascular complications, including diabetic kidney disease, neuropathy, and retinopathy. The relationship between HbA(1c) reduction and cardiovascular disease prevention in patients with diabetes is more complex, with data from large randomized trials published over the past decade providing clear evidence that lowering of HbA(1c) per se is an inadequate marker for a therapeutic regimen's impact on cardiovascular outcomes and patient survival. Recent revisions in professional society guidelines moved away from uniform recommendations and toward a more nuanced, patient-centered approach to HbA(1c) therapeutic targets. The context and key evidence underpinning these recent changes are discussed in this paper, alongside a brief overview of HbA(1c) contemporary assays and their limitations. (C) 2016 by the American College of Cardiology Foundation.

[发布日期] 2016-12-06

[关键词] diabetes mellitus;macrovascular complications;prevention