In adults with diabetes aged ≥75 years, elevated all-cause mortality risk was observed only at HbA1c ≥9% (HR 1.51), while systolic blood pressure showed no significant association with mortality.
Cohort (n=43,732)
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Do the associations of HbA1c, systolic blood pressure, and LDL-C with mortality vary by age in adults with diabetes?
The impact of glycemic, blood pressure, and lipid levels on mortality in diabetes varies substantially by age, suggesting that less stringent HbA1c and blood pressure targets may be appropriate for patients ≥75 years, whereas strict lipid management remains critical.
Hazard Ratio: 1.51 (95% CI 1.19–1.91)
Optimization of HbA1c, blood pressure and cholesterol, referred to as the “ABCs”, is central to the management of diabetes. However, the age-specific associations of these factors with mortality in patients with diabetes remains unclear. In this prospective cohort study, 43,732 Chinese adults aged ≥ 40 years with diabetes were included from the China Cardiometabolic Disease and Cancer Cohort (4C) Study. Participants were stratified by age (< 55, 55-<65, 65-<75, ≥ 75 years). Cox proportional hazards regression and Fine-Gray competing risk models were employed to estimate the associations of HbA1c, systolic blood pressure (SBP), and low-density lipoprotein cholesterol (LDL-C) with all-cause, cardiovascular, and non-cardiovascular mortality across age groups. Relative importance and population attributable fractions (PAFs) were computed for each metabolic factor. During a median follow-up of 10.1 years, 3,975 deaths were documented. Age significantly modified the associations of HbA1c, SBP, and LDL-C with all mortality outcomes (all P for interaction < 0.05). Among participants aged < 75 years, HbA1c showed graded positive associations with all-cause, cardiovascular, and non-cardiovascular mortality. The SBP thresholds associated with increased mortality risk were 140 mmHg in those aged < 65 years and 160 mmHg in those aged 65–<75 years. Among those aged ≥ 75 years, however, the patterns of these associations differed markedly. Elevated mortality risk was observed only at HbA1c ≥ 9%, with a hazard ratio (HR) of 1.51 (95% confidence interval CI: 1.19–1.91) for all-cause mortality and a subdistribution hazard ratio (SHR) of 1.70 (95% CI: 1.23–2.36) for cardiovascular mortality, while SBP showed no significant association with any mortality outcome in this age group. Moreover, LDL-C emerged as a significant risk factor for cardiovascular mortality. Compared with participants with LDL-C < 1.8 mmol/L, those with LDL-C of 1.8–<2.6 mmol/L exhibited a significantly higher risk (SHR: 1.86; 95% CI: 1.11–3.11). Additionally, LDL-C had the largest PAF for cardiovascular mortality (9.6%) within this age group. The impacts of ABC factors on mortality risk vary substantially by age among adults with diabetes. In patients aged ≥ 75 years, less stringent glycemic and blood pressure targets may be appropriate, whereas lipid management remains critically important for reducing cardiovascular mortality.
Zhu et al. (Sat,) conducted a cohort in Diabetes (n=43,732). HbA1c, systolic blood pressure, and LDL cholesterol levels vs. Guideline-recommended targets or lower risk categories was evaluated on All-cause mortality (HbA1c ≥9% vs <7% in adults aged ≥75 years) (HR 1.51, 95% CI 1.19-1.91). In adults with diabetes aged ≥75 years, elevated all-cause mortality risk was observed only at HbA1c ≥9% (HR 1.51), while systolic blood pressure showed no significant association with mortality.