The Relation Between HbA(1c) and Cardiovascular Events in Patients With Type 2 Diabetes With and Without Vascular Disease

Guido Kranenburg; Yolanda van der Graaf; Joep van der Leeuw; Hendrik M. W. Nathoe; Gert Jan de Borst; L. Jaap Kappelle; Frank L. J. Visseren; Jan Westerink

doi:10.2337/dc15-0493

The Relation Between HbA(1c) and Cardiovascular Events in Patients With Type 2 Diabetes With and Without Vascular Disease

Guido Kranenburg, Yolanda van der Graaf, Joep van der Leeuw, Hendrik M. W. Nathoe, Gert Jan de Borst, L. Jaap Kappelle, Frank L. J. Visseren, Jan Westerink^*,

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

OBJECTIVE: Poor glycemic control is related to vascular events in patients with type 2 diabetes, but the presence of vascular disease might influence this relation. We evaluated the relation between glycemic control (HbA1c level) and new cardiovascular events and mortality in patients with type 2 diabetes, with and without vascular disease.

RESEARCH DESIGN AND METHODS: In a cohort of 1,687 patients with type 2 diabetes enrolled in the Second Manifestations of Arterial Disease (SMART) study, the continuous relation between HbA1c and cardiovascular events (composite of myocardial infarction, stroke, and vascular mortality) and all-cause mortality was evaluated with Cox proportional hazard analyses stratified for the presence of vascular disease.

RESULTS: During a median follow-up time of 6.1 years (interquartile range 3.1-9.5 years), a new cardiovascular event developed in 293 patients and 340 patients died. In all patients, the hazard ratio (HR) of the relation between HbA1c level and cardiovascular events was 1.06 (95% CI 0.97-1.17). A 1 percentage point higher HbA1c level was related to a 27% higher risk of a cardiovascular event in patients with type 2 diabetes without vascular disease (HR 1.27 [95% CI 1.06-1.51]), but not in patients with vascular disease (HR 1.03 [95% CI 0.93-1.15], P for interaction = 0.195). A 1 percentage point higher HbA1c level was related to a 16% higher risk of death (HR 1.16 [95% CI 1.06-1.28]) in patients with vascular disease and a nonsignificant 13% higher risk of all-cause mortality (HR 1.13 [95% CI 0.97-1.31]) in patients without vascular disease.

CONCLUSIONS: In patients with type 2 diabetes, there is a modest, but not statistically significant, relation between HbA1c level and cardiovascular events, and, as there was no statistically significant interaction, this relation was not different for patients with or without clinical manifestation of vascular disease.

Original language	English
Pages (from-to)	1930-1936
Number of pages	7
Journal	Diabetes Care
Volume	38
Issue number	10
DOIs	https://doi.org/10.2337/dc15-0493
Publication status	Published - Oct 2015

Keywords

HEMOGLOBIN A1C LEVEL
GLYCOSYLATED HEMOGLOBIN
GLUCOSE CONTROL
GLYCEMIC CONTROL
MELLITUS
COMPLICATIONS
OUTCOMES
THERAPY
RISK
INTERVENTION

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10.2337/dc15-0493

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@article{623bfadb85514214b3618b7f998ea21a,

title = "The Relation Between HbA(1c) and Cardiovascular Events in Patients With Type 2 Diabetes With and Without Vascular Disease",

abstract = "OBJECTIVE: Poor glycemic control is related to vascular events in patients with type 2 diabetes, but the presence of vascular disease might influence this relation. We evaluated the relation between glycemic control (HbA1c level) and new cardiovascular events and mortality in patients with type 2 diabetes, with and without vascular disease.RESEARCH DESIGN AND METHODS: In a cohort of 1,687 patients with type 2 diabetes enrolled in the Second Manifestations of Arterial Disease (SMART) study, the continuous relation between HbA1c and cardiovascular events (composite of myocardial infarction, stroke, and vascular mortality) and all-cause mortality was evaluated with Cox proportional hazard analyses stratified for the presence of vascular disease.RESULTS: During a median follow-up time of 6.1 years (interquartile range 3.1-9.5 years), a new cardiovascular event developed in 293 patients and 340 patients died. In all patients, the hazard ratio (HR) of the relation between HbA1c level and cardiovascular events was 1.06 (95% CI 0.97-1.17). A 1 percentage point higher HbA1c level was related to a 27% higher risk of a cardiovascular event in patients with type 2 diabetes without vascular disease (HR 1.27 [95% CI 1.06-1.51]), but not in patients with vascular disease (HR 1.03 [95% CI 0.93-1.15], P for interaction = 0.195). A 1 percentage point higher HbA1c level was related to a 16% higher risk of death (HR 1.16 [95% CI 1.06-1.28]) in patients with vascular disease and a nonsignificant 13% higher risk of all-cause mortality (HR 1.13 [95% CI 0.97-1.31]) in patients without vascular disease.CONCLUSIONS: In patients with type 2 diabetes, there is a modest, but not statistically significant, relation between HbA1c level and cardiovascular events, and, as there was no statistically significant interaction, this relation was not different for patients with or without clinical manifestation of vascular disease.",

keywords = "HEMOGLOBIN A1C LEVEL, GLYCOSYLATED HEMOGLOBIN, GLUCOSE CONTROL, GLYCEMIC CONTROL, MELLITUS, COMPLICATIONS, OUTCOMES, THERAPY, RISK, INTERVENTION",

author = "Guido Kranenburg and {van der Graaf}, Yolanda and {van der Leeuw}, Joep and Nathoe, {Hendrik M. W.} and {de Borst}, {Gert Jan} and Kappelle, {L. Jaap} and Visseren, {Frank L. J.} and Jan Westerink",

year = "2015",

month = oct,

doi = "10.2337/dc15-0493",

language = "English",

volume = "38",

pages = "1930--1936",

journal = "Diabetes Care",

issn = "0149-5992",

publisher = "American Diabetes Association Inc.",

number = "10",

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TY - JOUR

T1 - The Relation Between HbA(1c) and Cardiovascular Events in Patients With Type 2 Diabetes With and Without Vascular Disease

AU - Kranenburg, Guido

AU - van der Graaf, Yolanda

AU - van der Leeuw, Joep

AU - Nathoe, Hendrik M. W.

AU - de Borst, Gert Jan

AU - Kappelle, L. Jaap

AU - Visseren, Frank L. J.

AU - Westerink, Jan

PY - 2015/10

Y1 - 2015/10

N2 - OBJECTIVE: Poor glycemic control is related to vascular events in patients with type 2 diabetes, but the presence of vascular disease might influence this relation. We evaluated the relation between glycemic control (HbA1c level) and new cardiovascular events and mortality in patients with type 2 diabetes, with and without vascular disease.RESEARCH DESIGN AND METHODS: In a cohort of 1,687 patients with type 2 diabetes enrolled in the Second Manifestations of Arterial Disease (SMART) study, the continuous relation between HbA1c and cardiovascular events (composite of myocardial infarction, stroke, and vascular mortality) and all-cause mortality was evaluated with Cox proportional hazard analyses stratified for the presence of vascular disease.RESULTS: During a median follow-up time of 6.1 years (interquartile range 3.1-9.5 years), a new cardiovascular event developed in 293 patients and 340 patients died. In all patients, the hazard ratio (HR) of the relation between HbA1c level and cardiovascular events was 1.06 (95% CI 0.97-1.17). A 1 percentage point higher HbA1c level was related to a 27% higher risk of a cardiovascular event in patients with type 2 diabetes without vascular disease (HR 1.27 [95% CI 1.06-1.51]), but not in patients with vascular disease (HR 1.03 [95% CI 0.93-1.15], P for interaction = 0.195). A 1 percentage point higher HbA1c level was related to a 16% higher risk of death (HR 1.16 [95% CI 1.06-1.28]) in patients with vascular disease and a nonsignificant 13% higher risk of all-cause mortality (HR 1.13 [95% CI 0.97-1.31]) in patients without vascular disease.CONCLUSIONS: In patients with type 2 diabetes, there is a modest, but not statistically significant, relation between HbA1c level and cardiovascular events, and, as there was no statistically significant interaction, this relation was not different for patients with or without clinical manifestation of vascular disease.

AB - OBJECTIVE: Poor glycemic control is related to vascular events in patients with type 2 diabetes, but the presence of vascular disease might influence this relation. We evaluated the relation between glycemic control (HbA1c level) and new cardiovascular events and mortality in patients with type 2 diabetes, with and without vascular disease.RESEARCH DESIGN AND METHODS: In a cohort of 1,687 patients with type 2 diabetes enrolled in the Second Manifestations of Arterial Disease (SMART) study, the continuous relation between HbA1c and cardiovascular events (composite of myocardial infarction, stroke, and vascular mortality) and all-cause mortality was evaluated with Cox proportional hazard analyses stratified for the presence of vascular disease.RESULTS: During a median follow-up time of 6.1 years (interquartile range 3.1-9.5 years), a new cardiovascular event developed in 293 patients and 340 patients died. In all patients, the hazard ratio (HR) of the relation between HbA1c level and cardiovascular events was 1.06 (95% CI 0.97-1.17). A 1 percentage point higher HbA1c level was related to a 27% higher risk of a cardiovascular event in patients with type 2 diabetes without vascular disease (HR 1.27 [95% CI 1.06-1.51]), but not in patients with vascular disease (HR 1.03 [95% CI 0.93-1.15], P for interaction = 0.195). A 1 percentage point higher HbA1c level was related to a 16% higher risk of death (HR 1.16 [95% CI 1.06-1.28]) in patients with vascular disease and a nonsignificant 13% higher risk of all-cause mortality (HR 1.13 [95% CI 0.97-1.31]) in patients without vascular disease.CONCLUSIONS: In patients with type 2 diabetes, there is a modest, but not statistically significant, relation between HbA1c level and cardiovascular events, and, as there was no statistically significant interaction, this relation was not different for patients with or without clinical manifestation of vascular disease.

KW - HEMOGLOBIN A1C LEVEL

KW - GLYCOSYLATED HEMOGLOBIN

KW - GLUCOSE CONTROL

KW - GLYCEMIC CONTROL

KW - MELLITUS

KW - COMPLICATIONS

KW - OUTCOMES

KW - THERAPY

KW - RISK

KW - INTERVENTION

U2 - 10.2337/dc15-0493

DO - 10.2337/dc15-0493

M3 - Article

C2 - 26307606

SN - 0149-5992

VL - 38

SP - 1930

EP - 1936

JO - Diabetes Care

JF - Diabetes Care

IS - 10

ER -

The Relation Between HbA(1c) and Cardiovascular Events in Patients With Type 2 Diabetes With and Without Vascular Disease

Abstract

Keywords

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