Hernandez, DomingoEspejo-Gil, AnaBernal-Lopez, M. RosaMancera-Romero, JoseBaca-Osorio, Antonio J.Tinahones, Francisco J.Armas-Padron, Ana M.Ruiz-Esteban, PedroTorres, ArmandoGómez-Huelgas, Ricardo2014-02-242014-02-242013-07-17Hernandez D, Espejo-Gil A, Bernal-Lopez MR, Mancera-Romero J, Baca-Osorio AJ, Tinahones FJ, et al. Association of HbA1c and cardiovascular and renal disease in an adult Mediterranean population. BMC Nephrol. 2013; 14(1):151.http://hdl.handle.net/10668/1517JOURNAL ARTICLEBACKGROUND: 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.enGlycated hemoglobinChronic kidney diseaseCardiovascular diseaseEspañaAndalucíaEstudios transversalesAdultosEnfermedades cardiovascularesInsuficiencia renal crónicaHemoglobina A GlucosiladaMedical Subject Headings::Geographicals::Geographic Locations::Europe::SpainMedical Subject Headings::Named Groups::Persons::Age Groups::AdultMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cross-Sectional StudiesMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Probability::Risk::Risk FactorsMedical Subject Headings::Diseases::Cardiovascular DiseasesMedical Subject Headings::Diseases::Male Urogenital Diseases::Urologic Diseases::Kidney Diseases::Renal Insufficiency::Renal Insufficiency, ChronicMedical Subject Headings::Diseases::Female Urogenital Diseases and Pregnancy Complications::Female Urogenital Diseases::Urologic Diseases::Kidney Diseases::Renal Insufficiency::Renal Insufficiency, ChronicMedical Subject Headings::Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Proteins::Blood Proteins::Hemoglobins::Hemoglobin A::Hemoglobin A, Glycosylatedresearch article23865389open access10.1186/1471-2369-14-1511471-2369PMC3720537