OBJECTIVEPoor glycemic control is related to vascular events in patients with type 2 diabetes, but the presence of vascular disease might influence this relation. We evaluated the relation between glycemic control (HbA 1c level) and new cardiovascular events and mortality in patients with type 2 diabetes, with and without vascular disease.
RESEARCH DESIGN AND METHODSIn a cohort of 1,687 patients with type 2 diabetes enrolled in the Second Manifestations of Arterial Disease (SMART) study, the continuous relation between HbA 1c and cardiovascular events (composite of myocardial infarction, stroke, and vascular mortality) and all-cause mortality was evaluated with Cox proportional hazard analyses stratified for the presence of vascular disease.
RESULTSDuring a median follow-up time of 6.1 years (interquartile range 3.1-9.5 years), a new cardiovascular event developed in 293 patients and 340 patients died. In all patients, the hazard ratio (HR) of the relation between HbA 1c level and cardiovascular events was 1.06 (95% CI 0.97-1.17
CONCLUSIONSIn patients with type 2 diabetes, there is a modest, but not statistically significant, relation between HbA 1c level and cardiovascular events, and, as there was no statistically significant interaction, this relation was not different for patients with or without clinical manifestation of vascular disease.Strict glycemic control has been proposed as an important means to lower the risk of both microvascular and macrovascular complications of type 2 diabetes. A strong relation between glycemic control and microvascular complications (nephropathy, retinopathy, and neuropathy) and macrovascular complications is observed in patients