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Coronary artery disease severity modifies associations between glycemic control and both mortality and myocardial
Sridharan Raghavan1, Wenhui G Liu2, P Michael Ho3
1Veterans Affairs Eastern Colorado Healthcare System, Denver, CO, United States; Division of General Internal Medicine, University of Colorado School of Medicine, Denver, CO, United States.
Insights
Coronary artery disease (CAD) severity influences how hemoglobin A1c (HbA1c) levels affect mortality and heart attack risk in patients with type 2 diabetes. Tailoring diabetes management based on CAD severity is crucial for personalized care.
Area of Science:
- Cardiology
- Endocrinology
- Clinical Medicine
Background:
- Type 2 diabetes is a significant risk factor for cardiovascular disease.
- Hemoglobin A1c (HbA1c) is a key marker for long-term glycemic control.
- Coronary artery disease (CAD) severity varies widely among diabetic patients.
Purpose of the Study:
- To investigate if CAD severity modifies the association between HbA1c and short-term clinical outcomes.
- To determine the impact of different HbA1c levels on mortality and myocardial infarction (MI) based on CAD severity.
Main Methods:
- Analysis of 17,394 US Veterans with type 2 diabetes undergoing cardiac catheterization.
- Categorization of CAD severity into obstructive, non-obstructive, or no CAD.
- Multivariable Cox regression with time-varying HbA1c and CAD severity interaction for mortality and MI prediction.
Main Results:
- CAD severity significantly moderated the relationship between HbA1c and both mortality and MI.
- Low HbA1c was linked to higher mortality in obstructive and non-obstructive CAD, but not in no CAD.
- High HbA1c was associated with increased MI risk solely in patients with obstructive CAD.
Conclusions:
- The impact of HbA1c on mortality and MI is dependent on the severity of underlying CAD.
- Incorporating cardiovascular disease severity assessments can guide individualized diabetes management strategies.
Aims:
This study examined whether the association between hemoglobin A1c (HbA1c) and short-term clinical outcomes is moderated by CAD severity.
Methods:
We studied 17,394 US Veterans with type 2 diabetes who underwent elective cardiac catheterization between 2005 and 2013. CAD severity was categorized as obstructive, non-obstructive, or no CAD. Using multivariable Cox proportional hazards regression, we assessed associations between time-varying HbA1c and two-year all-cause mortality and non-fatal MI, with an interaction term between HbA1c and CAD severity.
Results:
61%, 22%, and 17% of participants had obstructive, non-obstructive, and no CAD, respectively. CAD severity modified the relationship between HbA1c and each outcome (interaction p-value 0.0005 for mortality and <0.0001 for MI). Low HbA1c (<42 mmol/mol) was associated with increased mortality, relative to HbA1c of 48-52 mmol/mol, in individuals with obstructive CAD (HR 1.52 [1.17, 1.97]) and non-obstructive CAD (HR 2.61 [1.61, 4.23]), but not in those with no CAD (HR 0.91 [0.46, 1.79]). In contrast, higher HbA1c levels (≥53 mmol/mol) were associated with increased MI risk only in individuals with obstructive CAD.
Conclusions:
The associations between HbA1c and mortality and MI were moderated by CAD severity. Measures of cardiovascular disease severity may inform optimal individualized diabetes management.
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