Evidence map›Paper›PMID 25929925›Full record

ArticleMedicine2015

Hemoglobin a1c levels and the risk of cardiovascular disease in people without known diabetes: a population-based cohort study in Japan.

Atsushi Goto, Mitsuhiko Noda, Yumi Matsushita, Maki Goto, Masayuki Kato, Akihiro Isogawa, Yoshihiko Takahashi, Kayo Kurotani, Shino Oba, Akiko Nanri and 11 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Medicine, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
21citing papers in PubMed, 1 pooled it
2.7field-weighted citation impact, top 9% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

21 citing papers in PubMed, 1 synthesis or guideline pooled it, 37 citations in OpenAlex.

  1. Pooled it
  2. Mechanisms Linking Sleep-Disordered Breathing and Cardiometabolic Disease Risk.Arteriosclerosis, thrombosis, and vascular biology · 2026
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  16. Observational
  17. Atherosclerotic Cardiovascular Risk in Japan.Japanese clinical medicine · 2017
    Review
  18. Article
  19. Article
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

21 authors at 10 institutions in 2 countries.

Atsushi GotoFrom the Departments of Diabetes Research, Diabetes Research Center, National Center for Global Health and Medicine, Tokyo, Japan (AG, MN, MG, MK); Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan (AG); Departments of Clinical Research (YM) and Epidemiology and Prevention (KK, AN, TM), National Center for Global Health and Medicine, Tokyo, Japan; Department of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan (AI); Division of Diabetes and Metabolism, Iwate Medical University School of Medicine, Iwate, Japan (YT); Department of Health Promotion, National Institute of Public Health, Saitama, Japan (SO); Department of Public Health Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (KY); Department of Public Health, Fujita Health University, Aichi, Japan (HY); Department of Basic Nursing and Health Science, Ehime University Graduate School of Medicine, Ehime, Japan (IS); Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan (YK); Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan (NS, ST); AXA Department of Health and Human Security (MI) and Diabetes and Metabolic Diseases (TK), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Public Health, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Osaka, Japan (HI).
Mitsuhiko Noda
Yumi Matsushita
Maki Goto
Masayuki Kato
Akihiro Isogawa
Yoshihiko Takahashi
Kayo Kurotani
Shino Oba
Akiko Nanri
Tetsuya Mizoue
Kazumasa Yamagishi
Hiroshi Yatsuya
Isao Saito
Yoshihiro Kokubo
Norie Sawada
Manami Inoue
Hiroyasu Iso
Takashi Kadowaki
Shoichiro Tsugane
JPHC Study Group
National Center for Global Health and Medicine · JPCenter for Global Health · USEhime University · JPIwate Medical University · JPMitsui Memorial Hospital · JPNational Cerebral and Cardiovascular Center · JPNational Institute of Public Health · JPOsaka University · JPThe University of Tokyo · JPUniversity of Tsukuba · JP

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

High hemoglobin A1c (HbA1c) levels are strongly associated with an increased risk of cardiovascular disease (CVD) in people with and without diabetes. However, information regarding the relationship between low HbA1c levels and the risk of CVD among people without known diabetes is limited. The aim of this large-scale, prospective, population-based cohort study was to clarify the association between HbA1c levels and CVD risk among people without known diabetes.We followed-up 10,980 men and 18,079 women (46-80 years old and free of CVD and cancer at baseline) in the Japan Public Health Center-based Prospective Study. Using Cox models, we estimated the hazard ratios for CVD risk with adjustments for age, sex, geographic areas, body mass index, smoking status, sports and physical exercise, alcohol intake, systolic blood pressure, non-high-density lipoprotein cholesterol, and high-density lipoprotein cholesterol.During the median follow-up of 9.4 years, 935 CVD events (770 strokes and 165 coronary heart diseases) occurred. We observed a nonlinear association between HbA1c levels and CVD risk in participants without known diabetes. Compared with HbA1c levels of 5.0 to 5.4% (31-36 mmol/mol), the hazard ratios for CVD in participants without known diabetes were 1.50 (95% confidence interval: 1.15-1.95), 1.01 (0.85-1.20), 1.04 (0.82-1.32), and 1.77 (1.32-2.38) for HbA1c levels of <5.0% (<31 mmol/mol), 5.5 to 5.9% (37-41 mmol/mol), 6.0 to 6.4% (42-47 mmol/mol), and ≥6.5% (≥48 mmol/mol), respectively (P value for nonlinear trend: <0.001). In addition, the hazard ratio for CVD was 1.81 (1.43-2.29) in patients with known diabetes compared with participants with HbA1c levels of 5.0 to 5.4% and without known diabetes. This nonlinear relation persisted after excluding people with kidney dysfunction, liver dysfunction, anemia, body mass index <18.5 kg/m, or early events within 3 years of follow-up (P value for nonlinear trend: <0.01 for all tests).In conclusion, both low and high levels of HbA1c were associated with a higher risk of CVD in a Japanese general population without known diabetes.

Indexed as

AgedAged, 80 and overCardiovascular DiseasesFemaleFollow-Up StudiesGlycated HemoglobinHumansJapanMaleMiddle AgedProspective StudiesRisk FactorsGlycated Hemoglobin

Identifiers

PMID25929925
PMCPMC4603057
OpenAlexW2066915127

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.