In newly-diagnosed T2DM, mean HbA1c <6.0% versus 6.5-<7.0% was associated with an increased risk of stroke (HR 1.29; 95% CI 1.02-1.63) and ischemic heart disease (HR 1.65; 95% CI 1.25-2.19).
Case-Control (n=11,426)
Does the level of mean HbA1c control affect the risk of cardiovascular events in newly-diagnosed T2DM patients?
Early and sustained HbA1c control between 6.5 and <7.0% appears to minimize cardiovascular risk in newly-diagnosed T2DM patients, with both higher and lower HbA1c levels associated with increased risk.
Objectives: The objective of this study was to identify factors associated with stroke, myocardial infarction (MI), all-cause mortality, or a diagnosis of ischemic heart disease (IHD) or unstable angina (UA), among patients newly-diagnosed with type 2 diabetes (T2DM) with no recent history of cardiovascular (CV) events who rapidly achieve and maintain HbA1c ≤8.0%.Methods: Data were obtained from the Clinical Practice Research Datalink (CPRD) from January 1990 to December 2012. A nested case-control design was used with Cox proportional hazards analysis. Cases were identified by the first occurrence of stroke, MI, IHD, UA, or death within 5 years after HbA1c ≤ 8.0% was first reached (index date) following T2DM diagnosis. Controls were selected using a risk-set sampling approach and were matched 4:1 to cases using index date, exposure time, age, gender, and HbA1c at index date.Results: A total of 11,426 T2DM patients met the inclusion criteria for cases. Of these, 5,261 experienced a CV event. Stroke was the most frequent CV event (40%), followed by IHD (29%), MI (22%), and UA (9%). Mean HbA1c ≥7.0% over the length of exposure (vs 6.5 to <7.0%) was associated with an increased risk of stroke, MI, and IHD. The use of anti-platelet medications at baseline was also associated with increased risk of stroke (HR = 1.82 CI = 1.60–2.06), MI (HR = 1.67 CI = 1.38–2.03), and IHD (HR = 1.85 CI = 1.57–2.17). Mean HbA1c < 6.0% was associated with increased risk of stroke (HR = 1.29 CI = 1.02–1.63) and IHD (HR = 1.65 CI = 1.25–2.19). Use of nitrate medications at baseline was associated with increased risk of MI (HR = 2.83 CI = 2.24–3.57), IHD (HR = 4.32 CI = 3.57–5.22), and UA (HR = 10.38 CI = 7.67–14.03).Conclusions: Early and sustained HbA1c control between 6.5 and <7.0% appears to be an important modifiable factor that helps reduce CV risk in patients with newly-diagnosed T2DM in real-world clinical practice.
Alatorre et al. (Wed,) conducted a case-control in Type 2 diabetes (n=11,426). Mean HbA1c <6.0% or ≥7.0% vs. Mean HbA1c 6.5 to <7.0% was evaluated on First occurrence of stroke, myocardial infarction, ischemic heart disease, unstable angina, or death. In newly-diagnosed T2DM, mean HbA1c <6.0% versus 6.5-<7.0% was associated with an increased risk of stroke (HR 1.29; 95% CI 1.02-1.63) and ischemic heart disease (HR 1.65; 95% CI 1.25-2.19).