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Effect of Intensive Glycemic and Blood Pressure Control on QT Prolongation in Diabetes: The ACCORD Trial

Matthew J Singleton1, Elsayed Z Soliman2,3, Alain G Bertoni4

  • 1Section of Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC mjsingle@wakehealth.edu.

Diabetes
|August 1, 2020
PubMed

Insights

Intensive glycemic control in the ACCORD trial did not increase QT prolongation risk. This suggests that QT prolongation is unlikely to explain the increased mortality seen with intensive glycemic control.

Area of Science:

  • Cardiology
  • Endocrinology
  • Clinical Research

Background:

  • Intensive glycemic control in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial was associated with increased mortality.
  • Preliminary data suggested a link between intensive glycemic control, QT prolongation, and potentially fatal ventricular arrhythmias.

Purpose of the Study:

  • To investigate the impact of intensive glycemic control on the risk of incident QT prolongation.
  • To assess whether intensive blood pressure control affects the risk of QT prolongation.

Main Methods:

  • Cox proportional hazards models were used to compare QT prolongation risk between intensive and standard glycemic control arms.
  • QT prolongation was defined as QTc >460 ms in women or >450 ms in men.
  • Follow-up data from 48,634 person-years were analyzed.

Main Results:

  • No increased risk of QT prolongation was observed in the intensive glycemic control group compared to standard control.
  • Intensive blood pressure control also did not significantly alter the risk of prolonged QTc.
  • Sensitivity analyses using different QT correction formulas confirmed these findings.

Conclusions:

  • QT prolongation is unlikely to be the mechanism explaining the increased mortality associated with intensive glycemic control in the ACCORD trial.
  • The study provides evidence against a direct link between intensive glycemic/blood pressure control strategies and QT prolongation-related arrhythmias.

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