scholarly journals Impact of secondhand smoke exposure in former smokers on their subsequent risk of coronary heart disease: evidence from the population-based cohort of the Tehran Lipid and Glucose Study

2020 ◽  
Vol 42 ◽  
pp. e2020009 ◽  
Author(s):  
Masoumeh Sadeghi ◽  
Maryam S. Daneshpour ◽  
Soheila Khodakarim ◽  
Amir Abbas Momenan ◽  
Mahdi Akbarzadeh ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Proportional Hazards ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Smoking Intensity ◽  
Chd Risk ◽  
Median Period ◽  
Former Smokers ◽  
Never Smokers

OBJECTIVES: Cigarette smoking is an established, strong, and modifiable risk factor for coronary heart disease (CHD). However, little research has investigated CHD risk in former smokers who continue to be exposed to others’ cigarette smoke (former & secondhand smokers).METHODS: In the Tehran Lipid and Glucose Study, a prospective population-based cohort (n=20,069) was followed up for a median period of 14.6 years. A subset of 8,050 participants of 30 years of age and older was analyzed, with first CHD events as the study outcome. Participants were categorized as never, former, current, secondhand, and former & secondhand smokers. Data on smoking intensity (cigarette/d) were also collected. A Cox proportional hazards regression model was applied to estimate the risk of CHD, taking into account the main potential confounders.RESULTS: The mean age of participants was 46.10 ±11.38 years, and they experienced 1,118 first CHD events (with most CHD cases in former smokers) during the follow-up period. The risk of CHD was highest in current smokers, followed in order by former & secondhand, former, and secondhand smokers (hazard ratio [HR], 1.99; 95% confidence interval [CI], 1.65 to 2.39; HR, 1.55; 95% CI, 1.15 to 2.08; HR, 1.39; 95% CI, 1.12 to 1.72; HR, 1.27; 95% CI, 1.07 to 1.51, respectively), compared to never smokers. The risk of CHD increased with smoking intensity, which has been proposed as a preferable measure of smoking, indicating a dose-response pattern.CONCLUSIONS: The elevated risk of CHD in former & secondhand smokers was a noteworthy finding, with possible implications for health policy; however, further research is needed.

Abstract P316: Prehypertension and Incident Acute Coronary Heart Disease in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Stephen P Glasser ◽  
Yulia Khodneva ◽  
Daniel Lackland ◽  
Ronald Prineas ◽  
Monika Safford
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Racial Differences ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Community Dwelling ◽  
Cox Proportional Hazards Models ◽  
Chd Risk ◽  
Regards Study ◽  
Chd Risk Factors

Objective: The independent prognostic value of prehypertension (preHTN) for incident coronary heart disease (CHD) remains unsettled. Using the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study, we examined associations between preHTN and incident acute CHD and CVD death. Methods: REGARDS includes 30,239 black and white community-dwelling adults age 45 and older at baseline. Recruitment occurred from 2003-7, with baseline interviews and in-home data collection for physiologic measures. Follow-up is conducted by telephone every 6 months to detect events and deaths, which are adjudicated by experts. Systolic BP was categorized into <120 mmHg (n=4385), 120-129 mmHg (n=4000), 130-139 (n=2066), and hypertension was categorized into controlled (<140/90 mmHg on treatment) (n=8378), and uncontrolled (>140/90 mmHg) (n=5364). Incident acute CHD was defined as definite or probable myocardial infarction (MI) or acute CHD death. CVD death was defined as acute CHD, stroke, heart failure or other cardiovascular disease related. Cox proportional hazards models estimated the hazard ratios (HR) for incident CHD by BP categories, adjusting for sociodemographics and CHD risk factors. Results: The 23,393 participants free of CHD at baseline were followed for a median of 4.4 years. Mean age was 64.1, 58% were women and 42% were black. There was a significant interaction between sex and BP categories, therefore analyses were stratified by sex. There were 252 non-fatal and fatal acute CHD events among women and 407 among men. Among women, compared with SBP<120 mmHg, BP categories above SBP 120 mmHg were associated with incident CHD (adjusted HR for SBP120-129 mmHg=1.94 {95% CI 1.04-3.62]; SBP 130-139 mmHg=1.92 {0.95-3.87}; controlled HTN=2.16 {1.25-3.75}; uncontrolled HTN=3.25 {1.87-5.65}) in fully adjusted models. Among men, only uncontrolled HTN was associated with incident CHD (HR=1.55 {1.11-2.17}). Conclusion: In this sample, preHTN may be associated with incident CHD among women but not men.

Abstract P041: Serum Magnesium and the Incidence of Coronary Heart Disease Over 20 Years of Follow-up: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Mary R Rooney ◽  
Jeffrey R Misialek ◽  
Alvaro Alonso ◽  
Aaron R Folsom ◽  
Erin D Michos ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Proportional Hazards ◽  
Serum Magnesium ◽  
A Priori ◽  
Cox Proportional Hazards ◽  
Chd Risk ◽  
Chd Risk Factors ◽  
Aric Study

Introduction: Low serum magnesium (Mg) levels have been associated with increased coronary heart disease (CHD) risk, likely acting through pathways such as hypertension, hyperglycemia or inflammation. An early (1998) ARIC paper evaluated this association, based on 319 events, and identified a sex-interaction whereby the inverse Mg-CHD association was stronger among women than men. Nearly 2,000 events have occurred since the prior publication. Hence, we sought to update the analysis. Hypothesis: We hypothesized serum Mg would be inversely and independently associated with long-term risk of CHD. Methods: A total of 14,465 ARIC study participants without CHD at visit 1 (baseline) were included. Serum Mg was measured at visit 1 (1987-89) and visit 2 (1990-92). Incident CHD events were identified through 2014 using annual telephone calls, hospital discharge lists and death certificates, and were adjudicated by physician review. Multivariable Cox proportional hazards regression models were used. Serum Mg was categorized into quintiles based on mean visit 1 and 2 concentrations. Based on prior findings in ARIC suggesting an interaction, we decided a priori to provide sex-stratified results. Results: Participants at baseline were mean±SD age 54±6y, 57% were women and 27% black. Serum Mg was 1.62±0.14 mEq/L overall, 1.62±0.14 mEq/L among women and 1.63±0.14 mEq/L among men. Over a median follow-up of 25 years, 1,939 CHD cases were identified. Overall, serum Mg was inversely and monotonically associated with CHD risk after adjustment for demographics, lifestyle factors and other CHD risk factors (Table, p-trend<0.001). The association was stronger among women (HR Q5 vs Q1=0.63) than men (HR=0.83), but the sex-interaction was not statistically significant (p>0.05). Conclusions: In this large community-based cohort, serum Mg was inversely associated with CHD risk. This association was slightly stronger among women than men. Further research is needed to understand if increasing Mg levels is a useful target for CHD prevention.

Impact of smoking on the development of idiopathic pulmonary fibrosis: results from a nationwide population-based cohort study

Thorax ◽  
2021 ◽  
pp. thoraxjnl-2020-215386
Author(s):  
Won Bae ◽  
Chang-Hoon Lee ◽  
Jinwoo Lee ◽  
Young Whan Kim ◽  
Kyungdo Han ◽  
...  
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Large Scale ◽  
Proportional Hazards ◽  
Smoking Status ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Smoking Intensity ◽  
Cox Proportional Hazards Models ◽  
Former Smokers

BackgroundSmoking has been considered an important risk factor for idiopathic pulmonary fibrosis (IPF) incidence. However, there are no population-based large-scale studies demonstrating the effects of smoking on the development of IPF. We aimed to evaluate the effect of smoking on IPF development using a nationwide population-based cohort.MethodsUsing the Korean National Health Information Database, we enrolled individuals who had participated in the health check-up service between 2009 and 2012. Participants having a prior diagnosis of IPF were excluded. The history of smoking status and quantity was collected by a questionnaire. We identified all cases of incident IPF through 2016 on the basis of ICD-10 codes for IPF and medical claims. Cox proportional hazards models were used to calculate the adjusted HR (aHR) of the development of IPF.ResultsA total of 25 113 individuals (0.11%) with incident IPF were identified out of 23 242 836 participants registered in the database. The risk of IPF was significantly higher in current and former smokers than in never smokers, with an aHR of 1.66 (95% CI 1.61 to 1.72) and 1.42 (95% CI 1.37 to 1.48), respectively. Current smokers had a higher risk of IPF than former smokers (aHR 1.17, 95% CI 1.13 to 1.21). The risk of IPF development increased as the smoking intensity and duration increased.ConclusionSmoking significantly increased the risk of IPF development. Current smokers had a higher risk of IPF than former smokers. A dose–response relationship was observed between smoking and the development of IPF.

scholarly journals Risk of coronary heart disease among cancer survivors with different prediagnosis body mass index

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ahryoung Ko ◽  
Kyuwoong Kim ◽  
Joung Sik Son ◽  
Yu Jin Cho ◽  
Sang Min Park ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cancer Survivors ◽  
Body Mass ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Cancer Site ◽  
Chd Risk

AbstractAssociation between body mass index (BMI) and coronary heart disease (CHD) in cancer survivors is not clearly established. This study analyzed the prediagnosis BMI-CHD association by examining 13,500 cancer survivors identified from the National Health Insurance Service-Health Screening Cohort from January 1, 2004 to December 31, 2009 including the patients who were free of cardiovascular disease at enrollment. The Cox proportional hazards model (adjusted for socioeconomic, health behavior, health status, and medical characteristics) was used for calculating hazard ratios (HR) and 95% confidence intervals (95% CI) for CHD in each prediagnosis BMI category among cancer survivors. Compared to cancer survivors with a prediagnosis BMI between 18.5 and 22.9 kg/m2, those with a prediagnosis BMI of 23.0–24.9 kg/m2 and ≥ 25.0 kg/m2 had significantly higher CHD risk (HR = 1.51; 95% CI: 1.13–2.01 and HR = 1.38; 95% CI: 1.04–1.84, respectively). Cancer survivors with a low prediagnosis BMI (< 18.5 kg/m2) also had significantly higher CHD risk (HR = 1.97; 95% CI: 1.20–3.24) compared to those with a BMI of 18.5–22.9 kg/m2. Similar associations were found after stratifying analyses based on first cancer site and sociodemographic and medical characteristic subgroups. Our study suggests that prediagnosis underweight among patients with cancer is a predictor of CHD risk.

Abstract MP53: Consumption Of Ultra-processed Food Is Associated With Risk Of Coronary Heart Disease In The Atherosclerosis Risk In Communities Study

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Shutong Du ◽  
Hyunju Kim ◽  
Josef Coresh ◽  
Casey M Rebholz
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Food Intake ◽  
Proportional Hazards ◽  
Sociodemographic Factors ◽  
Incidence Rates ◽  
Cox Proportional Hazards ◽  
Processed Food ◽  
Cox Proportional Hazards Models ◽  
Food And Drink

Introduction: Ultra-processed food defined as food and drink products formulated through sequences of industrial processes, and generally contain non-culinary used additives. Previous studies have linked higher ultra-processed food intake with several cardiometabolic and cardiovascular diseases. However, longitudinal evidence from US populations remains scarce. Hypothesis: We hypothesized that higher intake of ultra-processed food is associated with higher risk of coronary heart disease (CHD). Methods: We selected 12,607 adults aged 44-66 years in 4 US communities from the ARIC study at baseline. Dietary intake data were collected through a validated 66-item food frequency questionnaire. Ultra-processed foods were defined using the NOVA classification and the level of intake was calculated for each participant. We conducted Cox proportional hazards models to study the association between quartiles of ultra-processed food intake and incident CHD. Nonlinearity was assessed by using restricted cubic spline regression. Results: There were 1,899 incident CHD cases documented after an median follow up of 27 years (291,285.2 person-years). Incidence rates were higher in the highest quartile of ultra-processed food intake (71.6 per 10,000 person-years; 95% CI, 65.8-78.0) compared to the lowest quartile (59.7 per 10,000 person-years; 95% CI, 54.3-65.7). Participants in the highest vs. lowest quartile were associated with a 18% higher risk of CHD (Hazard ratio 1.18 [95% CI, 1.04 - 1.34]; P-trend = 0.010) after adjusting for sociodemographic factors and health behaviors. An approximately linear relationship was observed between ultra-processed food intake and risk of CHD after 4 servings/day ( Figure ). Conclusion: In conclusion, higher ultra-processed food intake was associated with a higher risk of coronary heart disease among middle-aged US adults. Further prospective studies are needed to confirm these findings and to investigate the mechanisms by which ultra-processed food may affect health.

Abstract P323: Pulse Pressure and Incident Acute Coronary Heart Disease Events in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Stephen P Glasser ◽  
Daniel L Halberg ◽  
Charles Sands ◽  
Paul Muntner ◽  
Monika Safford
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Racial Differences ◽  
Pulse Pressure ◽  
Proportional Hazards ◽  
Linear Trend ◽  
Cox Proportional Hazards ◽  
Cvd Risk

Background: Increased attention has been given to pulse pressure (PP) as a potential independent risk factor of cardiovascular disease. We examined the relationship between PP and incident acute coronary heart disease (CHD). Methods: We used data from the REasons for Geographic And Racial Differences in Stroke (REGARDS) national cohort study of 30,239 black and white participants aged 45 years or older and enrolled between 2003 and 2007. Baseline data included a 45-minute interview and in-home visit during which blood pressure was assessed and recorded as the average of two measurements obtained after a 5 minute seated rest. PP (SBP-DBP) was classified into 4 groups (<45, 45-54, 54.1-64, >64.1 mmHg). Telephone follow-up occurred every six months for self or proxy-reported suspected events, triggering medical record retrieval and adjudication by experts. Cox-proportional hazards models examined the association of incident CHD with PP groups, adjusting for socio-demographic and clinical risk factors. Results: This analysis included 22,909 participants free of CHD at baseline, with mean age 64.7±9.4 years; 40.4%were black, 44.6% were male and they experienced a total of 515 incident CHD events over a mean 3.4 yrs of follow-up (maximum 6 years). In unadjusted analyses, compared with PP<45 mmHg, each higher PP group had incrementally higher hazard ratios (HR) for incident CHD (HR 1.28 {95% CI 1.02-1.60}, 2.05 {1.63-2.56}, 3.82 {3.08-4.74}, p<0.001 for linear trend). This relationship persisted after fully adjusting including SBP for the highest PP group (HR 0.96 {0.75-1.21}, 1.12 {0.86-1.46}, 1.51 {1.09-2.10}, p trend <0.0001). Conclusions: High PP was associated with incident CHD, even when accounting for SBP and numerous other CVD risk factors.

scholarly journals Association of Mid- to Late-Life Blood Pressure Patterns With Risk of Subsequent Coronary Heart Disease and Death

2021 ◽  
Vol 8 ◽  
Author(s):  
Menghui Liu ◽  
Shaozhao Zhang ◽  
Xiaohong Chen ◽  
Xiangbin Zhong ◽  
Zhenyu Xiong ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Proportional Hazards ◽  
Late Life ◽  
Cox Proportional Hazards ◽  
Atherosclerosis Risk In Communities ◽  
Cox Proportional Hazards Models ◽  
Significant Difference ◽  
All Cause Mortality

Background: The elevated blood pressure (BP) at midlife or late-life is associated with cardiovascular disease and death. However, there is limited research on the association between the BP patterns from middle to old age and incident coronary heart disease (CHD) and death.Methods: A cohort of the Atherosclerosis Risk in Communities (ARIC) Study enrolled 9,829 participants who attended five in-person visits from 1987 to 2013. We determined the association of mid- to late-life BP patterns with incident CHD and all-cause mortality using multivariable-adjusted Cox proportional hazards models.Results: During a median of 16.7 years of follow-up, 3,134 deaths and 1,060 CHD events occurred. Compared with participants with midlife normotension, the adjusted hazard ratio for all-cause mortality and CHD was 1.14 (95% CI, 1.04–1.25) and 1.28 (95% CI, 1.10–1.50) in those with midlife hypertension, respectively. In further analyses, compared with a pattern of sustained normotension from mid- to late-life, there was no significant difference for the risk of incident death (HR, 1.15; 95% CI, 0.96–1.37) and CHD (HR, 1.33; 95% CI, 0.99–1.80) in participants with a pattern of midlife normotension and late-life hypertension with effective BP control. A higher risks of death and CHD were found in those with pattern of mid- to late-life hypertension with effective BP control (all-cause mortality: HR, 1.24; 95% CI, 1.08–1.43; CHD: HR, 1.65; 95% CI 1.30–2.09), pattern of midlife normotension and late-life hypertension with poor BP control (all-cause mortality: HR, 1.27; 95% CI, 1.12–1.44; CHD: HR, 1.53; 95% CI, 1.23–1.92), and pattern of mid- to late-life hypertension with poor BP control (all-cause mortality: HR, 1.49; 95% CI, 1.30–1.71; CHD: HR, 1.87; 95% CI, 1.48–2.37).Conclusions: The current findings underscore that the management of elderly hypertensive patients should not merely focus on the current BP status, but the middle-aged BP status. To achieve optimal reductions in the risk of CHD and death, it may be necessary to prevent, diagnose, and manage of hypertension throughout middle age.

Abstract 2231: Thoracic Aortic Calcification and Coronary Heart Disease Events: the Multi-Ethnic Study of Atherosclerosis (MESA)

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Matthew J Budoff ◽  
Khurram Nasir ◽  
Ronit Katz ◽  
Junichiro Takasu ◽  
J Jeffrey Carr ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Population Based ◽  
Risk Factor Modification ◽  
Chd Risk ◽  
Hazard Ratios ◽  
Coronary Events ◽  
Thoracic Aortic Calcification ◽  
Independent Marker

Background: The presence of coronary artery calcium (CAC) is an independent marker of cardiovascular disease (CVD) events and mortality. However, the predictive value of thoracic aorta calcification (TAC), which can be additionally examined without further scanning during assessment of CAC, in predicting coronary heart disease (CHD) events in asymptomatic women and men, is not well-established. Methods: We collected data on risk factors and performed scanning for both TAC and CAC in a multi-ethnic population-based cohort of 6809 individuals (62±10 years, 47% males). Using the same images for each participant, TAC and CAC were computed using the Agatston method. The study subjects had no clinical cardiovascular disease at entry and were followed for a median of 4.1 years. Results: The mean age of the study population was 62±10 years (47% males). At baseline 1904 (28%) participants had detectable TAC, whereas 3392 (50%) had CAC>0. During the follow-up interval, 189 (2.78%) and 108 (1.59%) participants suffered any CHD and hard CHD event, respectively. Table below provide the hazard ratio (95% CI) for coronary events with presence of TAC. Overall TAC was a stronger predictor of CHD risk in women than in men. . Conclusion: Our study result suggests that TAC imparts independent prognostic power to predict future coronary events in women and may provide rationale for more intensive risk factor modification. Hazard Ratios (95% CI) of All CHD and Hard CHD Events with TAC (TAC>0 vs. TAC=0)

scholarly journals Corrected QT Interval Is Associated With Stroke but Not Coronary Heart Disease: Insights From a General Chinese Population

2021 ◽  
Vol 8 ◽  
Author(s):  
Xiaofan Guo ◽  
Zhao Li ◽  
Ying Zhou ◽  
Shasha Yu ◽  
Hongmei Yang ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Chinese Population ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Qtc Interval ◽  
Increased Risk ◽  
General Chinese Population

Background: Prolonged heart rate-corrected QT (QTc) interval has been associated with incident cardiovascular diseases (CVD) in general Western populations. However, this association is unclear in Asian population. We aim to estimate the association between QTc interval and incident CVD in a general Chinese population.Methods: We analyzed 8,867 participants age ≥35 years and free of CVD at baseline in the Northeast China Rural Cardiovascular Health Study. A resting 12-lead electrocardiogram was performed on all participants, and QTc interval computed using the Framingham formula. Cox proportional hazards models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for associations between QTc interval and incident stroke, coronary heart disease, and combined CVD events.Results: Over a median follow-up of 4.66 years, a total of 439 CVD events occurred (298 stroke cases and 152 CHD cases). After full adjustment, prolonged QTc defined by a sex-specific cutoff was associated with increased risk of developing stroke (HR: 1.82, 95% CI 1.20–2.75, P = 0.004) and combined CVD (HR: 1.52, 95% CI 1.05–2.19, P = 0.026). Spline analyses demonstrated no clear thresholds; when modeled as a linear relationship, each 10 ms increase of QTc interval was associated with an HR of 1.12 (95% CI 1.06–1.19, P &lt; 0.001) for stroke and an HR of 1.10 (95% CI 1.05–1.15, P &lt; 0.001) for combined CVD. Baseline QTc interval was not associated with incident CHD with either modeling strategy.Conclusions: Baseline QTc interval is associated with incident stroke and CVD in adults without prior CVD from a general Chinese population.

Abstract 11: Fructosamine and Glycated albumin with Risk of Coronary Heart Disease and Death

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Elizabeth Selvin ◽  
Andreea M Rawlings ◽  
Pamela L Lutsey ◽  
James S Pankow ◽  
Linda Kao ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Proportional Hazards ◽  
Glycated Albumin ◽  
Total Mortality ◽  
Cox Proportional Hazards ◽  
Risk Of Death ◽  
Cox Proportional Hazards Models ◽  
Pearson's R ◽  
Pearson’S R

Background: HbA1c is the standard measure to monitor glucose control and is now used for diagnosis of diabetes. Fructosamine and glycated albumin are markers of short-term glycemic control that may add complementary information to HbA1c. However, the associations of fructosamine and glycated albumin with cardiovascular outcomes are uncharacterized. Methods: We measured glycated albumin and fructosamine in 11104 adult participants (792 with a history of diabetes) of the community-based ARIC Study without cardiovascular disease at baseline (1990-1992). We evaluated the associations of fructosamine and glycated albumin with incident coronary heart disease and total mortality. We compared these associations to those for HbA1c. Results: Baseline HbA1c was highly correlated with fructosamine (Pearson’s r =0.82) and glycated albumin (Pearson’s r=0.86). During over two decades of follow-up there were 1,032 new cases of coronary heart disease and 2,594 deaths. In Cox proportional hazards models adjusted for traditional cardiovascular risk factors, elevated baseline levels of fructosamine and glycated albumin were significantly associated with coronary heart disease and total mortality ( Figure ). After additional adjustment for HbA1c, the associations were attenuated but remained significant, particularly at diabetic levels of fructosamine and glycated albumin. The associations with death were J-shaped, with an elevation of risk also apparent at the lowest levels of each biomarker, as has been previously observed for HbA1c. Conclusions: The acceptance of new measures of hyperglycemia is partly dependent on establishing their association with long-term outcomes. We found that fructosamine and glycated albumin were associated with coronary heart disease and mortality and that these associations were similar to those observed for HbA1c. The elevated risk of death at very low levels of fructosamine, glycated albumin, and HbA1c deserves further examination.

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