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HbA 1c as a risk factor for heart failure in persons with diabetes: the Atherosclerosis Risk in Communities (ARIC)

A Pazin-Filho1, A Kottgen, A G Bertoni

  • 1Medical School of Ribeirao Preto, University of Sao Paulo, Sao Paulo, Brazil.

Diabetologia
|October 2, 2008
PubMed

Insights

Elevated HbA1c levels increase heart failure risk in individuals with diabetes, regardless of coronary heart disease (CHD) status. Tight glycemic control may reduce heart failure incidence in this population.

Area of Science:

  • Cardiology
  • Endocrinology
  • Epidemiology

Background:

  • Heart failure (HF) incidence is rising in diabetic populations, with or without coronary heart disease (CHD).
  • Understanding the relationship between glycemic control and HF risk is crucial for prevention strategies.

Purpose of the Study:

  • To investigate the association between glycated hemoglobin (HbA1c) levels and the risk of developing heart failure (HF) in individuals with diabetes.
  • To determine if this association differs in the presence or absence of coronary heart disease (CHD).

Main Methods:

  • Analysis of 1,827 participants with diabetes from the Atherosclerosis Risk in Communities (ARIC) study, free of HF at baseline.
  • Cox proportional hazard models were used, adjusting for demographics, lifestyle factors, and major CHD risk factors.

Main Results:

  • Crude HF incidence was significantly higher in participants with CHD compared to those without (56.4 vs 15.5 per 1,000 person-years).
  • Each 1% increase in HbA1c was associated with a 17% increased risk of HF in the non-CHD group (adjusted HR 1.17) and a 20% increased risk in the CHD group (adjusted HR 1.20).
  • Even when excluding prevalent and incident CHD cases, HbA1c remained an independent risk factor for HF (adjusted HR 1.20).

Conclusions:

  • Glycemic control, as measured by HbA1c, is an independent risk factor for incident heart failure in diabetic individuals.
  • These findings support the need for clinical trials evaluating tight glycemic control strategies to mitigate HF risk in diabetes.
  • Further research should focus on quantifying the impact of different treatment regimens on HF risk reduction.
Abstract

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