Association Between Long-Term Visit-to-Visit Hemoglobin A1c and Cardiovascular Risk in Type 2 Diabetes: The ACCORD Trial
| Autor: | Yong-Quan Huang, Tian-Yi Mu, Qun-Ying Zhang, Yan Cui, Yin Huang, Dan Huang |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
cardiovascular risk
medicine.medical_specialty endocrine system diseases Population Type 2 diabetes Cardiovascular Medicine chemistry.chemical_compound Diabetes mellitus Internal medicine Diseases of the circulatory (Cardiovascular) system Medicine Myocardial infarction education Stroke Original Research education.field_of_study business.industry nutritional and metabolic diseases Type 2 Diabetes Mellitus medicine.disease mortality HbA1c - hemoglobin A1c diabetes - quality of life Quartile chemistry RC666-701 ACCORD 07 trial Glycated hemoglobin Cardiology and Cardiovascular Medicine business |
| Zdroj: | Frontiers in Cardiovascular Medicine, Vol 8 (2021) Frontiers in Cardiovascular Medicine |
| ISSN: | 2297-055X |
| DOI: | 10.3389/fcvm.2021.777233 |
| Popis: | Background: To explore the association between visit-to-visit variability of glycated hemoglobin (HbA1c) and cardiovascular outcomes in the patients with type 2 diabetes mellitus (T2DM) of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study.Methods: We conducted a post-hoc analysis on the ACCORD population including 9,544 participants with T2DM. Visit-to-visit variability of HbA1c was defined as the individual SD, coefficient of variation (CV), and variability independent of the mean (VIM) across HbA1c measurements. The clinical measurements included primary outcome [the first occurrence of non-fatal myocardial infarction (MI), non-fatal stroke or cardiovascular death], total mortality, cardiovascular death, non-fatal MI event, non-fatal stroke, total stroke, heart failure, macrovascular events, and major coronary events (CHD).Results: Over a median follow-up of 4.85 years, 594 and 268 participants experienced all-cause mortality and cardiovascular mortality, respectively. After adjusting for baseline HbA1c levels and confounding factors, the adjusted hazard ratio (HR) comparing patients in the highest vs. the lowest quartile CV of HbA1c variability was 1.61 (95% CI 1.29–2.00) for the primary outcome. Similar trends for secondary outcome were also observed. There was no association between HbA1c fluctuation and non-fatal stroke. Noticeably, there was 66% greater risk for the all-cause mortality among patients in the highest vs. the lowest quartile (HR 1.66, 95% CI 1.27–2.17).Conclusions: Greater variability of HbA1c is associated with higher risk for cardiovascular complications and all-cause death in T2DM. Our study stresses the significance of well-controlled glycemic levels for improving cardiovascular outcomes. Further randomized clinical trials are required to confirm these findings. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|