We appreciate the thoughtful comments of Drs Echouffo-Tcheugui and colleagues on our article.1 We agree that diabetes status should not be treated as a cardiovascular disease (CVD) equivalent and that individualized risk estimates are preferred. While we also agree that hemoglobin A1c (HbA1c) may be a useful marker for both diabetic and nondiabetic patients, it is not yet universally available in nondiabetic patients and thus may not be practical as a risk marker in this group. We would also like to correct the misunderstanding that our results were due to a structural disadvantage between our CVD equivalent model and the HbA1c model. The CVD equivalent model was based on existing guidelines and refit to our data, making the footing as equal as possible, while retaining the ability to have a guideline-based comparison group.
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