Original Journal Article by Sinning C, Makarova N, Völzke H, et al. - In the general European population, an independent association of glycated hemoglobin A _1c (HbA _1c ) with cardiovascular mortality, overall mortality and cardiovascular disease was identified. Findings showed a mostly monotonically increasing link between HbA _1c levels and outcomes. In participants without diabetes, increased HbA _1c levels were related to cardiovascular disease incidence and overall mortality, highlighting the importance of HbA _1c levels in the overall population.

• By analyzing data from six prospective population-based cohort studies across Europe including 36,180 participants, HbA _1c was assessed together with classical cardiovascular risk factors for link with cardiovascular mortality, cardiovascular disease (CVD) incidence, and overall mortality in persons without diabetes (N = 32,496) and with diabetes (N = 3,684).

• Increasing HbA _1c levels were linked with higher event rates, and significant links were found between HbA _1c (in mmol/mol) in the total study population and the evaluated outcomes.

• Per 10 mmol/mol increase in HbA _1c was associated with a hazard ratio (HR) of 1.16 for cardiovascular mortality, 1.13 for CVD incidence, and 1.09 for overall mortality.

• The link with CVD incidence and overall mortality was also noted in those without diabetes with elevated HbA _1c levels (HR 1.12 and 1.10 respectively).

• HbA _1c cut-off values of 39.9 mmol/mol (5.8%), 36.6 mmol/mol (5.5%), and 38.8 mmol/mol (5.7%) for cardiovascular death, CVD incidence, and overall death, demonstrated also an elevated risk.