Diabetes and Metabolism Journal

Korean Diabetes Association (대한당뇨병학회)
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Association of Hemoglobin A1c with Cardiovascular Disease Risk Factors and Metabolic Syndrome in Nondiabetic Adults

당뇨병이 없는 성인에서 심혈관질환 위험요소 및 대사증후군과 당화혈색소의 상관관계

Kim, Jin-Hwa;Choi, So-Ra;Lee, Jae-Rok;Shin, Ji-Hye;Lee, Sang-Jun;Han, Mi-Ah;Park, Jong;Bae, Hak-Yeon;Kim, Sang-Yong
김진화;최소라;이재록;신지혜;이상준;한미아;박종;배학연;김상용

  • Published : 2008.10.01
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Abstract

Background: Glycosylated hemoglobin (HbA1c) is a useful index of mean blood glucose concentrations over the preceding 2 to 3 months. Elevated HbA1c levels (> 7%) are associated with a higher incidence of microvascular and macrovascular complications in patients with diabetes mellitus. However, the relationship between HbA1c and cardiovascualr disease risk in nondiabetic adults has been unclear. The aim of this study is to estimate the association of HbA1c with cardiovascular disease risk factors and metabolic syndrome in nondiabetic adults. Methods: The subjects of this study included 533 adults (180 males and 353 females) aged 20~70 years (mean age: 46.9 ± 10.12 years) without previously diagnosed diabetes who lived in Kangyang country. We examined baseline HbA1c levels and cardiovascular risk factors. Metabolic syndrome was defined based on International Diabetes Federation guidelines. Results: The prevalence of metabolic syndrome significantly increased as HbA1c increased. HbA1c revealed a significant correlation with age (r = 0.258, P < 0.001), BMI (r = 0.152, P < 0.001), waist circumference (r = 0.252, P < 0.001), fasting plasma glucose (r = 0.319, P < 0.001), systolic (r = 0.100, P = 0.021), diastolic (r = 0.115, P = 0.008) blood pressure, total cholesterol (r = 0.232, P < 0.001), triglyceride (r = 0.156, P < 0.001), LDL cholesterol (r = 0.216, P < 0.001), and HDL cholesterol (r = -0.167, P < 0.001). Multiple regression analysis showed that HbA1c had a association with age, fasting plasma glucose, and dyslipidemia. The receiver operating characterstics (ROC) curve analysis determined HbA1c of 5.35% to yield optimal sensitivity and specificity corresponding to the presence of metabolic syndrome. Conclusion: The HbA1c level is correlated with cardiovascular risk factors and prevalence of metabolic syndrome in nondiabetic adults. (KOREAN DIABETES J 32:435-444, 2008)

배경: 당뇨병환자에서 혈당상승 및 당화혈색소 상승 시 심혈관질환으로 인한 사망 위험률 또한 증가되며 당화혈색 소의 증가는 미세혈관 및 대혈관 합병증 증가와 연관된다는 연구들이 있다. 그러나 당뇨병이 없는 일반인구에서 혈당상 태와 심혈관질환 간의 연관성에 관해서는 명확히 밝혀져 있 지 않으며 특히, 당화혈색소와 심혈관질환 간의 관계에 관 한 연구는 많지 않다. 이에 저자 등은 전라남도 광양지역 20~70세의 당뇨병이 없는 일반 인구를 대상으로 당화혈색 소와 심혈관질환의 위험요소간의 연관관계를 분석하고 대사 증후군 발병과의 상관성을 평가하였다. 대상 및 방법: 2006년 8월 7일부터 2006년 9월 17일까지 전라남도 광양지역에 거주하는 20~70세의 당뇨병이 없는 성인 533명 (남성 180명, 여성 353명)을 대상으로 하였다. 당화혈색소와 심혈관질환의 위험요소를 조사하였고 대사증 후군은 International Diabetes Federation 기준을 적용하여 정의하였다. 결과: 남녀의 성비는 1:1.961로 여성이 더 많았으며 평균 연령은 46.9 ± 10.12세 (mean ± SD)였고, 평균 당화혈색소 는 5.3 ± 0.36%로 남녀간의 유의한 차이는 없었다. 당화혈 색소의 증가에 따라 대사증후군의 유병률이 유의하게 증가 하였고 연령, BMI, 허리둘레, 공복혈당, 수축기 혈압, 이완 기 혈압, 총 콜레스테롤, 중성지방, LDL 콜레스테롤과 유의 한 양의 상관관계를 나타내었으며 HDL 콜레스테롤과는 유 의한 음의 상관관계를 나타내었다. 특히, 공복혈당, HDL 콜 레스테롤, 연령, LDL 콜레스테롤, 중성지방은 변수를 보정 한 후에도 유의한 상관관계를 보였다. 대사증후군 진단에 상응하는 당화혈색소치를 ROC 곡선을 통하여 추정한 결과 5.35% (sensitivity; 0.547, 1-specificity; 0.319)였고, 공복혈 당 100 mg/dL에 상응하는 당화혈색소치는 5.45% (sensitivity; 0.614, 1-specificity; 0.219)였다. 결론:　당뇨병이 없는 성인에서 당화혈색소는 심혈관질환 의 위험요소와 유의한 연관관계를 보였고 당화혈색소의 증 가에 따라 대사증후군 유병률의 유의한 증가가 관찰되어 당 뇨병이 없는 사람들에서 당화혈색소가 대사증후군 및 심혈 관질환의 위험을 예측할 수 있는 하나의 인자로 이용될 수 있을 가능성을 제안한다.

Keywords

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