HbA1c was progressive risk factor for CV events

In patients with and without diabetes who had symptomatic chronic heart failure, HbA1c level was an independent, progressive risk factor for cardiovascular death, hospitalization for heart failure and total mortality, according to recent data.

Researchers from Canada, Sweden and other sites conducted a study of participants in the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) program (n=2,412) for a median of 34 months.

Risk rose progressively with higher levels of usual HbA1c (P<.001), according to the researchers. After adjustment for age and sex, HRs per 1% higher HbA1c increased 1.25-fold for the primary outcome of cardiovascular death or heart failure hospitalization; 1.24-fold for cardiovascular death; 1.25-fold for hospitalization for worsening heart failure; and 1.22-fold for total mortality (P<.001).

“This relationship was evident in patients with and without diabetes and with reduced or preserved ejection fraction and persisted after adjustment for diabetes, other risk factors and allocation to candesartan,” the researchers wrote. – by Christen Haigh

Arch Intern Med. 2008;168:1699-1704.

More cardiovascular disease physicians should be obtaining HbA1cs and doing everything possible to reduce risks in these patients, including aggressive use of statins, beta-blockers, ACE inhibitors and angiotensin II receptor antagonists in appropriate patients.

– James B. Young, MD

Chairman, Division of Medicine and Professor of Medicine, Cleveland Clinic Foundation