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HbA1c Levels and Long-Term Mortality in Patients Undergoing Coronary Angiography
Ofer Havakuk1, Shmuel Banai, Amir Halkin
1Department of Cardiology, Cardiovascular Research Center, Tel Aviv Medical Center, affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Insights
Glycated hemoglobin (HbA1c) levels below 5% or above 7% predict higher mortality in patients undergoing coronary angiography. This finding highlights the importance of glycemic control for cardiovascular outcomes.
Area of Science:
- Cardiology
- Endocrinology
- Clinical Research
Background:
- Previous research on the prognostic value of glycated hemoglobin (HbA1c) in patients undergoing coronary angiography has yielded inconsistent results.
- Defining the precise prognostic impact of HbA1c is crucial for risk stratification and patient management.
Purpose of the Study:
- To clarify the prognostic significance of HbA1c levels in individuals undergoing coronary angiography.
- To investigate the association between various HbA1c ranges and long-term mortality in this patient cohort.
Main Methods:
- A cohort of 3,749 patients undergoing coronary angiography was stratified into four HbA1c groups: <5%, 5-6%, 6-7%, and >7%.
- Cox regression models were employed to analyze long-term all-cause mortality, adjusting for multiple clinical covariates.
- Statistical analysis accounted for baseline clinical characteristics, comorbidities, anemia, nutritional status, renal function, cardiovascular risk factors, and inflammatory biomarkers.
Main Results:
- A J-shaped association was observed between HbA1c levels and all-cause mortality.
- Patients in the lowest (<5%) and highest (>7%) HbA1c groups exhibited significantly higher mortality rates compared to those with intermediate levels.
- These findings remained significant after adjusting for potential confounding factors, including anemia and cardiovascular risk indicators.
Conclusions:
- HbA1c levels outside the 5-7% range are significant predictors of all-cause mortality in patients undergoing coronary angiography.
- Both very low and very high HbA1c levels are associated with increased long-term mortality risk in this population.
Objectives:
Previous studies investigating the prognostic value of HbA1c in patients undergoing coronary angiography reported a mixed pattern of results. Therefore, we aimed to better define the prognostic power of HbA1c among coronary catheterized patients.
Methods:
Patients undergoing coronary angiography (n = 3,749) were divided into four groups according to HbA1c levels (<5, 5-6, 6-7 and >7%). Cox regression models assessed long-term mortality after adjusting for multiple covariates.
Results:
Baseline clinical profiles differed in HbA1c groups, with a higher prevalence of comorbidities in the groups with higher HbA1c levels. Median follow-up was 1,745 days (interquartile range 1,007-2,171). A J-shaped association curve was observed between HbA1c levels and all-cause mortality rates, with patients in the lowest and highest HbA1c groups suffering from significantly higher mortality rates compared to in-between groups (hazard ratio 1.9, 95% CI 1.32-2.74, p = 0.001, and hazard ratio 1.58, 95% CI 1.29-1.95, p < 0.001, for the lowest and highest HbA1c groups, respectively). This association persisted after adjustment for anemia, nutritional status, renal function, cardiovascular risk factors and inflammatory biomarkers.
Conclusions:
HbA1c levels <5 or >7% are predictors of all-cause mortality in patients undergoing coronary angiography.
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