Relationship between HbA1c levels and risk of cardiovascular adverse outcomes and all-cause mortality in overweight and obese cardiovascular high-risk women and men with type 2 diabetes

Abstract

Aims/hypothesis The optimal HbA 1c concentration for prevention of macrovascular complications and deaths in obese cardiovascular high-risk patients with type 2 diabetes remains to be established and was therefore studied in this post hoc analysis of the Sibutramine Cardiovascular OUTcomes (SCOUT) trial, which enrolled overweight and obese patients with type 2 diabetes and/or cardiovascular disease. Methods HRs for meeting the primary endpoint (nonfatal myocardial infarction, nonfatal stroke, resuscitated cardiac arrest or cardiovascular death) and all-cause mortality were analysed using Cox regression models. Results Of 8,252 patients with type 2 diabetes included in SCOUT, 7,479 had measurements of HbA 1c available at baseline (i.e. study randomisation). Median age was 62 years (range 51-86 years), median BMI was 34.0 kg/m 2 (24.8-65.1 kg/m 2 ) and 44% were women. The median HbA 1c concentration was 7.2% (3.8-15.9%) (55 mmol/l [18-150 mmol/l]) and median diabetes duration was 7 years (0-57 years). For each 1 percentage point HbA 1c increase, the adjusted HR for the primary endpoint was 1.17 (95% CI 1.11, 1.23); no differential sex effect was observed (p00.12 for interaction). In contrast, the risk of all-cause mortality was found to be greater in women than in men: HR 1.22 (1.10, 1.34) vs 1.12 (1.04, 1.20) for each 1 percentage point HbA 1c increase (p 00.02 for interaction). There was no evidence of increased risk associated with HbA 1c ≤6.4% (≤46 mmol/l). Glucose-lowering treatment regimens, diabetes duration or a history of cardiovascular disease did not modify the associations. Diabetologia (2012) 55:2348-2355 DOI 10.1007/s00125-012-2584 Conclusions/interpretation In overweight, cardiovascular high-risk patients with type 2 diabetes, increasing HbA 1c concentrations were associated with increasing risks of cardiovascular adverse outcomes and all-cause mortality.

The HbA1c and All-Cause Mortality Relationship in Patients with Type 2 Diabetes is J-Shaped: A Meta-Analysis of Observational Studies

“…The J-shaped trend conflicts with a recent observational study of a clinical trial conducted by Andersson et al who found no association between low HbA1c and increased mortality in overweight and obese patients not experiencing weight loss [8]. This could be caused by the difference in population groups between this study and the adjusted variables used in other studies.…”

“…Many clinical trials suggest a decrease in all-cause mortality as HbA1c values decrease [6][7][8], while others suggest that there is no association [9][10][11]. The debate has continued because of the early cessation of the Action to Control Cardiovascular Risk for Diabetes (ACCORD) trial [12], because there was an increased mortality in the treatment group that included patients who were trying to achieve low HbA1c levels.…”

Glucose, blood pressure and cholesterol levels and their relationships to clinical outcomes in type 2 diabetes: a retrospective cohort study

“…Findings compared with previous studies Recent trials have found that intensive glucose control is associated with increased risk of cardiovascular death in younger patients [8] and observational studies have generally demonstrated Ushaped relationships between levels of HbA 1c in diabetic patients and death [28,29], possibly attributable to residual confounding through unmeasured variables [12]. In our study we adjusted for several important confounders, including comorbidities such as heart failure, chronic obstructive airways disease and chronic kidney disease.…”

Cardiovascularis prevenció – 2016

“…A vérnyomás intenzív csökkentése szükséges, a célérték 140/85 Hgmm, amelynek szerepe van a micro-és macrosvascularis kockázat csökkentésében. A 130/80 Hgmm célérték esetén a stroke, retinopathia és albuminuria kialakulása csök-kenthető szelektált betegcsoport esetében [11].…”