Background
The possibility that hyperglycemia accounts for the 2–3 fold higher risk of ischemic heart disease (IHD) in type 2 diabetes was explored by assessing the effect of intensive glucose lowering on IHD in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial.
Methods
10,251 people (mean age = 62) with type 2 diabetes (mean duration = 10 years, mean A1c = 8.3%) were allocated to intensive or standard glycemic control targeting an A1c <6% or 7–7.9% respectively. This intervention’s effect on IHD (fatal or non-fatal myocardial infarction, coronary revascularization, unstable angina, and new angina) was assessed during a mean active treatment period of 3.7 years followed by an additional 1.2 years.
Results
Fewer participants allocated to the intensive versus standard care group experienced a myocardial infarction during both active treatment (HR = 0.80; 95% CI 0.67 – 0.96; P = 0.015) and full (active and additional) follow-up (HR = 0.84; 95% CI 0.72 – 0.97; P = 0.02). Similar findings were observed for a composite IHD outcome of myocardial infarction, coronary revascularization or unstable angina (HR = 0.89; 95% CI 0.79–0.99 and HR = 0.87; 95% CI 0.79 – 0.96 during active treatment and full follow-up respectively)and for coronary revascularization (HR = 0.84; 95% CI 0.75–0.94), and unstable angina (HR = 0.81; 95% CI 0.67–0.97) during full follow-up. Adding A1C levels achieved during active treatment attenuated the significant hazard ratios to neutrality.
Conclusions
Glucose elevation is a modifiable risk factor for IHD in middle aged people with type 2 diabetes and other IHD risk factors.
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