The Norfolk cohort of the European Prospective Investigation of Cancer and Nutrition (EPIC-Norfolk) Study34 determined at the end of 1999 the fate of 4662 men aged 45 to 79 years who had their HbA1c measured between 1995 and 1997. The group was subdivided into those with HbA1c levels below 5.0%, those with values between 5.0% and 5.4%, those with values between 5.5% and 6.9%, those with values above 7.0%, and those with self-reported diabetes. Risk for death from CVD, coronary artery disease, and all-cause mortality was assessed using the Cox proportional hazards model after correcting for age, blood pressure, serum cholesterol, body mass index, cigarette smoking, and prior myocardial infarction or stroke. Relative to individuals with HbA1c levels below 5.0%, those with values between 5.0% and 5.4% had an increased risk for CVD, coronary artery disease, and all-cause mortality of 2.5, 2.7, and 1.4, respectively, and for those with HbA1c levels above 7.0%, the respective relative risks were 5.0, 5.2, and 2.6 (Figure 3). Of interest, the presence or absence of diabetes was not a risk factor independent of HbA1c levels. This observation strongly suggests that hyperglycemia per se was the key factor.