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January 22, 2020
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Rising HbA1c levels contribute to CV event risk in diabetes, CAD

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The longitudinal increase of HbA1c was found to be independently associated with elevated incidence of CV events for patients with diabetes and multivessel CAD, according to findings published in JAMA Network Open.

Researchers found, after adjusting for age, sex, two-vessel or three-vessel CAD, initial CAD treatments, ejection fraction and creatinine and LDL levels, a 1-point increase in the longitudinal value of HbA1c was associated with a 22% higher risk for all-cause mortality, MI and stroke (HR = 1.22; 95% CI, 1.12-1.35).

“This study suggests that the control of glycemia and, consequently, HbA1c should focus not only on achieving strict, isolated levels but also on minimizing variation over time,” Paulo Cury Rezende, MD, PhD, clinical researcher at the Medicine, Angioplasty, or Surgery Research Group and collaborating professor of cardiology at the University of São Paulo Medical School, and colleagues wrote. “Especially in this population with multivessel CAD, in which control of diabetes might influence the occurrence of cardiac events, avoiding variation of HbA1c levels could have the potential to lower cardiovascular risk during a long-term follow-up period.”

Researchers assessed 725 patients who had diabetes, multivessel CAD and complete health records and HbA1c information during a median follow-up of 10 years (median age, 62 years; 64% men), with a mean of number of 9.5 HbA1c measurements per patient.

Researchers observed that the composite endpoint of all-cause mortality, MI or stroke occurred in 36.1% of the cohort during the study period.

“Although all patients underwent rigorous control of HbA1c during follow-up, performed by the same group of physicians using similar treatment strategies, it is possible that the patients with higher fluctuations of glycemia and, consequently, of HbA1c had more severe diabetes, less pancreatic reserve, and, thus, more difficulty controlling glycemia,” the researchers wrote. “Moreover, it is also possible this group of patients had lower adherence to the treatment.” – by Scott Buzby

Disclosures: The authors report no relevant financial disclosures.