Relationship between HbA1c levels and risk of cardiovascular adverse outcomes and all-cause mortality in overweight and obese cardiovascular high-risk women and men with type 2 diabetes
Diabetologia - Clinical and Experimental Diabetes and Metabolism, 05/31/2012
Andersson C et al. – In overweight, cardiovascular high–risk patients with type 2 diabetes, increasing HbA1c concentrations were associated with increasing risks of cardiovascular adverse outcomes and all–cause mortality.
HRs for meeting the primary endpoint (nonfatal myocardial infarction, nonfatal stroke, resuscitated cardiac arrest or cardiovascular death) and all–cause mortality were analysed using Cox regression models.
Of 8,252 patients with type 2 diabetes included in SCOUT, 7,479 had measurements of HbA1c available at baseline (i.e. study randomisation).
Median age was 62 years (range 51–86 years), median BMI was 34.0 kg/m2 (24.8–65.1 kg/m2) and 44% were women.
The median HbA1c concentration was 7.2% (3.8–15.9%) (55 mmol/l [18–150 mmol/l]) and median diabetes duration was 7 years (0–57 years).
For each 1 percentage point HbA1c increase, the adjusted HR for the primary endpoint was 1.17 (95% CI 1.11, 1.23); no differential sex effect was observed (p = 0.12 for interaction).
In contrast, the risk of all–cause mortality was found to be greater in women than in men: HR 1.22 (1.10, 1.34) vs 1.12 (1.04, 1.20) for each 1 percentage point HbA1c increase (p = 0.02 for interaction).
There was no evidence of increased risk associated with HbA1c ≤6.4% (≤46 mmol/l).
Glucose–lowering treatment regimens, diabetes duration or a history of cardiovascular disease did not modify the associations.
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