Fructosamine is a risk factor for myocardial infarction and all-cause mortality – Longitudinal experience from the AMORIS cohort
Introduction
Elevated fasting glucose is associated with an increased risk of myocardial infarction (MI) and cardiovascular death [1], [2], [3], [4]. Fasting plasma glucose and HbA1c are established indicators of glucose status and control while fructosamine is rarely used in clinical or research settings. Fructosamine reflects the average glucose level during the preceding 1–3 weeks [5], [6], [7]. The analytical method is simple, robust and inexpensive and can potentially be useful in risk prediction of micro- and macrovascular diseases either on its own or in combination with glucose and HbA1c. In the AMORIS (Apolipoprotein-related MOrtality RISk) cohort we have recently reported strong associations between fructosamine, glucose and HbA1c both cross-sectionally and longitudinally [8]. Furthermore, in the ARIC study [5] as well as in the KIHD study [9] fructosamine has been shown to predict incident diabetes. In addition, the ARIC study also showed associations of fructosamine and microvascular complications of diabetes [5], [10]. However, little is known about fructosamine as a risk predictor of macrovascular complications in long-term prospective studies with hard endpoints [11], [12]. The aim of this study was to evaluate if levels of fructosamine in the general population are associated with the incidence of MI and all-cause mortality respectively. We also evaluated possible differences between fructosamine, HbA1c and fasting glucose with respect to risk association for these endpoints.
Section snippets
Study population
The study included subjects of the Swedish AMORIS cohort described previously [13], [14], [15]. None of the subjects, 178,947 men and 159,496 women, were inpatient at baseline. Blood samples were obtained during 1985–1996 through routine health check-ups or primary care. Repeated blood sampling was performed in 44% of the subjects, e.g. through annual routine health check-ups. Subjects were 30 years or more at the index examination and had fructosamine, glucose, total cholesterol, triglycerides
General characteristics of the study population
The characteristics for the full cohort are summarized in Table 1. A total of 149,817 subjects (44%), mean age about 50 years, had repeated measurements of the biomarkers. Subjects were followed for up to 26 years with a mean follow-up time of 19 years. There were 21,526 events of MI during the follow-up period of which 18,792 non-fatal and 2734 fatal cases. The total number of deaths during the study period was 73,458. In the subset from 3178 subjects with data on smoking and hypertension
Discussion
Our findings show that elevated fructosamine levels are positively associated with the incidence of myocardial infarction (MI) and all-cause mortality. These associations are similar to those obtained by using the conventional HbA1c as a risk predictor. The new findings for fructosamine are based on a very large unselected study population with a wide range of fructosamine levels followed for a long period of time. Hence, fructosamine can be used to predict not only microvascular diseases as
Acknowledgment
We thank the principal investigators; Professor Lars Alfredsson and Professor Peter Westerholm (WOLF study (Work, Lipids and Fibrinogen)), Professor Alicija Wolk (COSM,SMC cohorts) and Professor Mai-Lis Hellenius (Sollentuna Primary Prevention Study) for generously sharing information regarding smoking, blood pressure and self-reported hypertension for the present study. This work was supported by the Jungner Foundation for Laboratory Medicine, Stockholm, Sweden [Dnr.1118/12-1]. The funder had
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