HbA1c and Coronary Heart Disease Risk Among Diabetic Patients

Abstract

OBJECTIVEClinical trials to date have not provided definitive evidence regarding the effects of glucose lowering with coronary heart disease (CHD) risk among diabetic patients.RESEARCH DESIGN AND METHODSWe prospectively investigated the association of HbA1c at baseline and during follow-up with CHD risk among 17,510 African American and 12,592 white patients with type 2 diabetes.RESULTSDuring a mean follow-up of 6.0 years, 7,258 incident CHD cases were identified. The multivariable-adjusted hazard ratios of CHD associated with different levels of HbA1c at baseline (<6.0 [reference group], 6.0–6.9, 7.0–7.9, 8.0–8.9, 9.0–9.9, 10.0–10.9, and ≥11.0%) were 1.00, 1.07 (95% CI 0.97–1.18), 1.16 (1.04–1.31), 1.15 (1.01–1.32), 1.26 (1.09–1.45), 1.27 (1.09–1.48), and 1.24 (1.10–1.40) (P trend = 0.002) for African Americans and 1.00, 1.04 (0.94–1.14), 1.15 (1.03–1.28), 1.29 (1.13–1.46), 1.41 (1.22–1.62), 1.34 (1.14–1.57), and 1.44 (1.26–1.65) (P trend <0.001) for white patients, respectively. The graded association of HbA1c during follow-up with CHD risk was observed among both African American and white diabetic patients (all P trend <0.001). Each one percentage increase of HbA1c was associated with a greater increase in CHD risk in white versus African American diabetic patients. When stratified by sex, age, smoking status, use of glucose-lowering agents, and income, this graded association of HbA1c with CHD was still present.CONCLUSIONSThe current study in a low-income population suggests a graded positive association between HbA1c at baseline and during follow-up with the risk of CHD among both African American and white diabetic patients with low socioeconomic status.

Sex differences in the risk of stroke and HbA1c among diabetic patients

“…The interaction between race and HbA1c on stroke risk was not significant. In a previous paper we described a graded positive association between HbA1c and CHD in both male and female members of this cohort [22]. In addition, we found that this graded positive association was present in African American and white female patients and in patients with and without glucose-lowering agent treatment.…”

“…In a geriatric population with considerable comorbidities, the competing risk of death is especially high. We described a graded positive association between HbA1c and CHD in both male and female members in a previous paper [22]. There is the possibility that men with higher HbA 1c values die of CHD rather than having a stroke.…”

“…LSU Health Care Services Division (LSU HCSD) operates seven public hospitals and affiliated clinics in Louisiana, which provide quality medical care regardless of the patient’s income or insurance coverage [14–22]. Since 1997, administrative, anthropometric, laboratory, clinical diagnosis, and medication data are available in electronic form.…”

MECHANISMS IN ENDOCRINOLOGY: Cardiovascular risk in women with type 2 diabetes mellitus and prediabetes: is it indeed higher than men?

“…However, a recent metaanalysis including data from 64 cohort studies (775 385 individuals) showed a higher risk for fatal and non-fatal stroke in women with DM compared with men with DM (1.27 (95% CI: 1.10-1.46; I 2 Z0%)), with no evidence of publication bias (24). Moreover, a recent prospective study including 17 510 African American and 12 592 white patients with type 2 DM did not find any sex difference in CHD risk at a given HbA1c level (25).…”

Relationship of Glycated Hemoglobin Levels with Myocardial Injury following Elective Percutaneous Coronary Intervention in Patients with Type 2 Diabetes Mellitus

“…There was compelling evidence suggested that the level of HbA1c predicted clinical cardiovascular disease or cardiovascular mortality [3]–[6]. However, the optimal glycemic control of diabetic patients with cardiovascular diseases was not well characterized.…”