Relationship between Hemoglobin A1c Levels and Metabolic Syndrome using Data Collected during a Medical Check-ups Program

Eun Hee Nah; Han-Ik Cho

doi:10.3343/lmo.2011.1.1.2

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Nah and Cho: Relationship between Hemoglobin A1c Levels and Metabolic Syndrome using Data Collected during a Medical Check-ups Program

Original Article

Clinical Chemistry

Laboratory Medicine Online

Laboratory Medicine Online 2011; 1(1): 3-9.

Published online: 1 January 2011

DOI: https://doi.org/10.3343/lmo.2011.1.1.2

Relationship between Hemoglobin A1c Levels and Metabolic Syndrome using Data Collected during a Medical Check-ups Program

Eun Hee Nah, Han-Ik Cho

Korea Association of Health Promotion, Seoul, Korea.

Corresponding author: Eun Hee Nah. Korea Association of Health Promotion, 1097 Hwagok 6-dong, Gangseo-gu, Seoul 157-704, Korea. Tel: +82-2-2601-7161, Fax: +82-2-2696-4500, cellonah@hanmail.net

Received 8 June 2010 Revised 3 August 2010 Accepted 14 September 2010

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Hemoglobin A1c (HbA1c) level is an indicator of the average blood glucose concentration of the past 2 to 3 months. Studies on the association of HbA1c levels with cardiovascular disease have reported inconsistent findings groups stratified by gender, age, and race. Therefore we conducted this study to determine the relationship between HbA1c levels and metabolic syndrome in a Korean population participating in medical check-up programs.

Methods

The study population comprised 7,301 nondiabetic Korean subjects (3,384 men and 3,917 women) who had enrolled for a medical check-up program. All subjects were divided into 5 groups on the basis of their HbA1c levels. Age, blood pressure, abdominal obesity, fasting glucose levels, lipid profile and high sensitivity C-reactive protein (hsCRP) levels were compared among the groups. In addition, we also investigated the association of HbA1c levels with cardiovascular risk factors and metabolic syndrome.

Results

Age, waist circumference, body mass index, blood pressure, hsCRP levels, lipid profile and fasting glucose levels differed significantly among the 5 HbA1c groups, both in men and women. The possibility of the occurrence of metabolic syndrome increased as HbA1c levels increased, both in men and women. Abdominal obesity was the most common component of metabolic syndrome and more prominently occurred in women.

Conclusions

HbA1c levels were significantly correlated to metabolic syndrome among these Korean subjects and abdominal obesity was the most frequently observed component of metabolic syndrome. Thus, abdominal obesity should be treated when high HbA1c levels are detected, particularly in women, even though the patient is not diabetic.

Keywords: Hemoglobin A1c, Metabolic syndrome, Abdominal obesity

Figures and Tables

Table 1

Clinical and biochemical characteristics of the subjects

Abbreviations: BP, blood pressure; BMI, body mass index; WC, waist circumference; T-cholesterol, total cholesterol; LDL-C, LDL-cholesterol; HDL-C, HDL-cholesterol; hsCRP, high sensitivity C-reactive protein; NS, not significant.

Table 2

Comparison of cardiovascular risk factors according to HbA1c levels

Abbreviations: Q, quartile. For other abbreviations. see Table 1.

Table 3

Odds ratio (95% CI) for each factor for metabolic syndrome according to HbA1c levels

^*P<0.05 in logistic regression analysis; ^†Non-adjusted; ^‡Age-adjusted.

Abbreviations: OR, odds ratio; CI, confidence interval.

Table 4

Prevalence and odds ratio for metabolic syndrome according to HbA1c levels

^*P<0.05.

Table 5

Prevalence of each component of metabolic syndrome in subjects fulfilling the criteria for diagnostic criteria of metabolic syndrome, analyzed by HbA1c levels

Notes

This article is available from http://www.labmedonline.org

References

1. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005. 112:2735–2752.

2. DeFronzo RA, Ferrannini E. Insulin resistance. A multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. Diabetes Care. 1991. 14:173–194.

3. Stern MP. Diabetes and cardiovascular disease. The "common soil" hypothesis. Diabetes. 1995. 44:369–374.

4. Gerstein HC, Yusurf S. Dysglycaemia and risk of cardiovascular disease. Lancet. 1996. 347:949–950.

5. Balkau B, Shipley M, Jarrett RJ, Pyorala K, Pyorala M, Forhan A, et al. High blood glucose concentration is a risk factor for mortality in middle-aged nondiabetic men. 20-year follow-up in the Whitehall Study, the Paris Prospective Study, and the Helsinki Policemen Study. Diabetes Care. 1998. 21:360–367.

6. Bjornholt JV, Erikssen G, Aaser E, Sandvik L, Nitter-Hauge S, Jervell J, et al. Fasting blood glucose: an underestimated risk factor for cardiovascular death. Results from a 22-year follow-up of healthy nondiabetic men. Diabetes Care. 1999. 22:45–49.

7. Park S, Barrett-Connor E, Wingard DL, Shan J, Edelstein S. GHb is a better predictor of cardiovascular disease than fasting or postchallenge plasma glucose in women without diabetes. The Rancho Bernardo Study. Diabetes Care. 1996. 19:450–456.

8. de Vegt F, Dekker JM, Ruhe HG, Stehouwer CD, Nijpels G, Bouter LM, et al. Hyperglycaemia is associated with all-cause and cardiovascular mortality in the Hoorn population: the Hoorn Study. Diabetologia. 1999. 42:926–931.

9. Khaw KT, Wareham N, Luben R, Bingham S, Oakes S, Welch A, et al. Glycated haemoglobin, diabetes, and mortality in men in Norfolk cohort of european prospective investigation of cancer and nutrition (EPIC-Norfolk). BMJ. 2001. 322:15–18.

10. Selvin E, Marinopoulos S, Berkenblit G, Rami T, Brancati FL, Powe NR, et al. Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Ann Intern Med. 2004. 141:421–431.

11. WHO West Pacific Region. The Asia-pacific perspective: refining obesity and its treatment. 2000. London: International Obesity Taskforce.

12. Yates AP, Laing I. Age-related increase in heamoglobin A1c and fasting plasma glucose in accompanied by a decrease in beta-cell function without change in insulin sensitivity: evidence from a cross-sectional study of hospital personnel. Diabet Med. 2002. 19:254–258.

13. Osei K, Rhinesmith S, Gaillard T, Schuster D. Is glycosylated hemoglobin A1c a surrogate for metabolic syndrome in nondiabetic, first-degree relatives of African-American patients with type 2 diabetes? J Clin Endocrinol Metab. 2003. 88:4596–4601.

14. Dilley J, Ganesan A, Deepa R, Deepa M, Sharada G, Williams OD, et al. Association of A1c with cardiovascular disease and metabolic syndrome in Asian Indians with normal glucose tolerance. Diabetes care. 2007. 30:1527–1532.

15. Bakker SJ, Dekker JM, Heine RJ. Association between HbA1c and HDL-cholesterol independent of fasting triglycerides in a Caucasian population: evidence for enhanced cholesterol ester transfer induced by in vivo glycation. Diabetologia. 1998. 41:1249–1250.

16. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010. 33:S. S62–S69.

17. Hunt KJ, Resendez RG, Williams K, Haffner SM, Stern MP. National Cholesterol Education Program versus World Health Organization metabolic syndrome in relation to all-cause and cardiovascular mortality in the San Antonio Heart Study. Circulation. 2004. 110:1251–1257.

18. Kahn BB, Flier JS. Obesity and insulin resistance. J Clin Invest. 2000. 106:473–481.

19. Nguyen QM, Srinivasan SR, Xu JH, Chen W, Berenson GS. Distribution and cardiovascular risk correlates of hemoglobin A(1c) in nondiabetic younger adults: the Bogalusa Heart Study. Metabolism. 2008. 57:1487–1492.

20. Srinivasan SR, Myers L, Berenson GS. Predictability of childhood adiposity and insulin for developing insulin resistance syndrome (syndrome X) in young adulthood: the Bogalusa Heart Study. Diabetes. 2002. 51:204–209.

21. Sung KC, Rhee EJ. Glycated haemoglobin as a predictor for metabolic syndrome in non-diabetic Korean adults. Diabet Med. 2007. 24:848–854.

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