HbA1c may improve models of cardiovascular risk assessment in diabetes

A blood sample

Clinical question

In people with diabetes, should HbA1c be included as a risk factor in assessments of cardiovascular risk?

This large, prospective cohort study looked at how well individual HbA1c values performed as predictors of cardiovascular risk in combination with existing risk assessment guidelines.

The evidence

Over 35,000 patients were followed for cardiovascular events.  69% were women, and 3.5% were diabetic.  During the study, 295 cardiovascular events were recorded, 12.5% of them in people with diabetes.

The researchers looked at whether HbA1c could predict the incidence of these events and concluded that cardiovascular risk assessment guidelines for people with diabetes should take account of HbA1c.

Appraisal hints

Users of this evidence should consider:

  • Which guidelines the researchers were using
  • Whether the guideline development methods conform to AGREE principles
  • Was the population equivalent to those in whom it would be used in real life
  • How the population was recruited
  • Duration of follow-up
  • It’s not clear from the abstract whether HbA1c was used for non-diabetic persons.


Paynter NP; Mazer NA et al. Cardiovascular Risk Prediction in Diabetic Men and Women Using Hemoglobin A1c vs Diabetes as a High-Risk Equivalent. Arch Intern Med. 2011;171(19):1712-1718. doi:10.1001/archinternmed.2011.351

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I am an information scientist with an interest in making knowledge from systematic research more accessible to people who need it. This means you. I've been attempting this in the area of Evidence-Based Health Care since 1995. So far the results have been mixed. For some reason we expected busy clinicians to search databases and appraise papers instead of seeing patients. We also expected publishers to make the research freely available to the people who paid for it.. Ha! Hence The National Elf service.

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