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Effects of glycaemic control on cardiovascular disease in diabetic American Indians: the Strong Heart Study

W Q Lu1, H E Resnick, K A Jablonski

  • 1MedStar Research Institute, Hyattsville, MD, and Washington Hospital Center, Washington, DC, USA.

Diabetic Medicine : a Journal of the British Diabetic Association
|March 31, 2004
PubMed

Insights

Poor glycemic control significantly increases cardiovascular disease (CVD) risk in individuals with diabetes. Maintaining good glycemic control is crucial for managing CVD risk in diabetic populations.

Area of Science:

  • Cardiology
  • Endocrinology
  • Public Health

Background:

  • Diabetes mellitus is a significant risk factor for cardiovascular disease (CVD).
  • Traditional risk factors like hypertension, obesity, and dyslipidemia only partially explain the elevated CVD risk in diabetic individuals.
  • Residual CVD risk in diabetes may be linked to glycemic control variations.

Purpose of the Study:

  • To investigate the association between glycemic control levels and the incidence of CVD in a diabetic population.
  • To determine if variations in glycated hemoglobin (A1c) levels correlate with cardiovascular event risk.

Main Methods:

  • Longitudinal data from the Strong Heart Study, including American Indians with high diabetes prevalence, were analyzed.
  • Diabetes was diagnosed using World Health Organization criteria (fasting or 2-h plasma glucose).
  • Glycemic control was categorized as good (A1c < 7%), fair (7-7.9%), or poor (≥ 8%) based on American Diabetes Association guidelines.

Main Results:

  • Over 9 years, 494 of 2011 diabetic participants developed CVD.
  • Kaplan-Meier analysis revealed significantly higher CVD and coronary heart disease (CHD) incidence in participants with poor glycemic control compared to those with good or fair control (P = 0.001).
  • While Cox regression showed trends, confounding variables weakened the dose-response relationship after adjustment.

Conclusions:

  • Poor glycemic control is a significant independent risk factor for cardiovascular disease and coronary heart disease in individuals with diabetes.
  • Effective management of blood pressure and lipid disorders remains critical for mitigating CVD risk in diabetic patients.
  • Emphasizing stringent glycemic control is essential for reducing cardiovascular complications in diabetes care.
Abstract

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