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Long-term variability in HbA1c, BP raises CVD risk in type 2 diabetes
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Long-term visit-to-visit variability in both HbA1c and systolic blood pressure increases the risk for cardiovascular disease in adults with type 2 diabetes, according to study findings reported in BMJ Open Diabetes Research & Care.
In a retrospective, observational cohort study of Japanese adults with type 2 diabetes, researchers also found a “synergistic effect” between HbA1c variability and mean systolic BP and the incidence of CVD.
“Even if mean [systolic] BP is maintained within the normal range, [systolic] BP variability can be a risk factor for a CVD event,” Toshiko Takao, of the division of diabetes and metabolism at The Institute for Adult Diseases, Asahi Life Foundation in Tokyo, and colleagues wrote. “Our findings indicate the possibility that stabilization of variability in HbA1c and [systolic] BP as well as lowering of their mean levels can be an efficient strategy for preventing the incidence of CVD.”
Takao and colleagues analyzed data from 632 Japanese adults with type 2 diabetes and no history of CVD at baseline who first visited the hospital from 1995 to 1996. Patients in the cohort attended at least four clinic visits, with at least one visit per year, and were followed until June 2012 for incident CVD confirmed through medical records and questionnaires (overall follow-up rate, 72%).
During follow-up, 81 patients (65 men) developed CVD.
Researchers found that the coefficient of variation and the variation independent of mean for HbA1c and systolic BP were significant predictors of CVD events, independent of mean HbA1c and systolic BP. Results persisted after multivariate analysis.
The researchers classified patients into four groups by median HbA1c coefficient of variation and systolic BP coefficient of variation values and by median HbA1c variation independent of mean and systolic BP variation independent of mean values; HRs were highest in the high-HbA1c coefficient of variation/high-systolic BP coefficient of variation and high-HbA1c variation independent of mean/high-systolic BP variation independent of mean groups, and they were significantly higher vs. those grouped in the low-HbA1c coefficient of variation/low-systolic BP coefficient of variation and low-HbA1c variation independent of mean/low-systolic BP variation independent of mean groups.
In addition, HRs associated with HbA1c coefficient of variation and HbA1c variation independent of mean were significantly elevated among patients with a mean systolic BP of 130 mm Hg or greater vs. patients with a mean systolic BP of 130 mm Hg or less.
“The risk of the incidence of CVD significantly increased 2.45-fold for each 1% increase in HbA1c [standard deviation] and 2.02-fold for every 10 mm Hg increase in [systolic] blood pressure [standard deviation],” the researchers wrote. “It is important that clinicians pay attention to variability in HbA1c and [systolic] BP, which may represent a higher [CV] risk than their mean values and can lead to combined additive risk for the incidence of CVD.” – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.
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