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 (p = 0.12 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 = 0.02 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.

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.

• Authors: C Andersson, L van Gaal, I D Caterson, P Weeke, W P T James, W Coutinho, W Couthino, N Finer, A M Sharma, A P Maggioni, C Torp-Pedersen
• Journal: Diabetologia (Diabetologia) Vol. 55 Issue 9 Pg. 2348-55 (Sep 2012) ISSN: 1432-0428 [Electronic] Germany
• PMID: 22638548 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Biomarkers
• Blood Glucose
• Glycated Hemoglobin A
• hemoglobin A1c protein, human

Topics

• Aged
• Aged, 80 and over
• Biomarkers (blood)
• Blood Glucose (metabolism)
• Body Mass Index
• Cardiovascular Diseases (blood, mortality, physiopathology)
• Diabetes Mellitus, Type 2 (blood, mortality, physiopathology)
• Female
• Follow-Up Studies
• Glycated Hemoglobin (metabolism)
• Humans
• Male
• Middle Aged
• Obesity (blood, mortality, physiopathology)
• Predictive Value of Tests
• Risk Factors