Abstract
BackgroundThe prognostic value of hemoglobin A1c (HbA1c) in coronary artery disease (CAD) remains controversial. Herein, we conducted a systematic review to quantify the association between elevated HbA1c levels and all-cause mortality among patients hospitalized with CAD.MethodsA systematic search of electronic databases (PubMed, EMBASE, OVID, Web of Science, The Cochrane Library) for studies published from 1970 to May 2011 was performed. Cohort, case-control studies, and randomized controlled trials that examined the effect of HbA1c on all-cause mortality were included.ResultsTwenty studies met final inclusion criteria (total n = 13, 224). From the pooled analyses, elevated HbA1c level was significantly associated with increased short-term (OR 2.32, 95% CI, 1.61 to 3.35) and long-term (OR 1.54, 95% CI, 1.23 to 1.94) mortality risk. Subgroup analyses suggested elevated HbA1c level predicted higher mortality risk in patients without diabetes (OR 1.84, 95% CI, 1.51 to 2.24). In contrast, in patients with diabetes, elevated HbA1c level was not associated with increased risk of mortality (OR 0.95, 95% CI, 0.70 to 1.28). In a risk-adjusted sensitivity analyses, elevated HbA1c was also associated with a significantly high risk of adjusted mortality in patients without diabetes (adjusted OR 1.49, 95% CI, 1.24 to 1.79), but had a borderline effect in patients with diabetes (adjusted OR 1.05, 95% CI, 1.00 to 1.11).ConclusionsOur findings demonstrate that elevated HbA1c level is an independent risk factor for mortality in CAD patients without diabetes, but not in patients with established diabetes. Prospective studies should further investigate whether glycemic control might improve outcomes in CAD patients without previously diagnosed diabetes.
Highlights
The prognostic value of hemoglobin A1c (HbA1c) in coronary artery disease (CAD) remains controversial
Numerous prior studies have shown that elevated admission or fasting glucose increases the risk of death and in-hospital complications in patients with acute coronary syndrome (ACS) and patients undergoing coronary revascularization [1,2,3,4,5]
The remaining studies were excluded largely because they did not include mortality as an outcome or did not provide mortality data according to HbA1c level; other subjects were included besides CAD patients; or reported HbA1c was in an unusable format
Summary
The prognostic value of hemoglobin A1c (HbA1c) in coronary artery disease (CAD) remains controversial. We conducted a systematic review to quantify the association between elevated HbA1c levels and all-cause mortality among patients hospitalized with CAD. Much attention has been paid to the glycometabolism in patients with coronary artery disease (CAD). Hemoglobin A1c (HbA1c) level is an indicator of average blood glucose concentrations over the preceding 2-3. To comprehensively analyze these data, we performed a systematic review to examine whether an association exists between elevated HbA1c and all-cause mortality in patients hospitalized with CAD Numerous prior studies have shown that elevated admission or fasting glucose increases the risk of death and in-hospital complications in patients with acute coronary syndrome (ACS) and patients undergoing coronary revascularization [1,2,3,4,5].
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