J-curve relationship between long term glycemic control and mortality in diabetic patients with acute myocardial
Ik Jun Choi1,2, Eun Ho Choo3,4, Hwa Jung Kim5
1Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Insights
Less strict glycemic control may be optimal for diabetic patients after acute myocardial infarction (AMI). A moderate HbA1c range (6.5-7.0%) was associated with the lowest mortality, particularly in elderly individuals.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Intensive glycemic control is standard for diabetic patients to prevent complications.
- The impact of glycemic control on mortality in diabetic patients with acute myocardial infarction (AMI) is not well-established.
Purpose of the Study:
- To investigate the relationship between glycemic control, measured by HbA1c levels, and all-cause mortality in diabetic patients following AMI.
- To determine the optimal HbA1c range for reducing mortality in this patient population.
Main Methods:
- A cohort of 1384 diabetic patients with AMI was selected from a multicenter registry.
- Patients were stratified into five groups based on mean HbA1c levels post-AMI (≤6.5%, 6.5-7.0%, 7.0-7.5%, 7.5-8.0%, >8.0%).
- All-cause mortality was the primary endpoint, with a median follow-up of 6.2 years.
Main Results:
- The lowest all-cause mortality was observed in patients with a mean HbA1c of 6.5% to 7.0%.
- Higher mortality risk was associated with HbA1c ≤6.5% (aHR 2.00) and HbA1c >8.0% (aHR 3.35) compared to the 6.5-7.0% group.
- A J-curve relationship between HbA1c and mortality was more pronounced in elderly patients (≥65 years).
Conclusions:
- Less strict glycemic control, targeting a mean HbA1c of 6.5-7.0%, appears optimal for reducing mortality in diabetic patients post-AMI.
- This finding is particularly relevant for elderly diabetic patients with AMI.
- The study suggests a potential need to reconsider intensive glycemic control targets in specific post-AMI diabetic populations.
Background:
Intensive glycemic control is generally recommended for diabetic patients to reduce complications. However, the role of glycemic control in the mortality in diabetic patients with acute myocardial infarction (AMI) remained unclear.
Methods:
We selected diabetic patients who measured HbA1c more than 3 times after AMI among 10,719 patients enrolled in the multicenter AMI registry. Patients (n = 1384) were categorized into five groups: according to mean HbA1c level: ≤ 6.5%, > 6.5 to ≤ 7.0%, > 7.0 to ≤ 7.5%, > 7.5 to ≤ 8.0% and > 8.0%. The primary endpoint was all-cause mortality.
Results:
During a median follow-up of 6.2 years, the patients with a mean HbA1c of 6.5 to 7.0% had the lowest all-cause mortality. Compared to patients with mean HbA1c of 6.5 to 7.0%, the risk of all-cause mortality increased in subjects with mean HbA1c ≤ 6.5% (adjusted hazard ratio [HR] 2.00, 95% confidence interval [CI] 1.02-3.95) and in those with mean HbA1c > 8.0% (adjusted HR 3.35, 95% CI 1.78-6.29). In the subgroup analysis by age, the J-curve relationship between mean HbA1c and all-cause mortality was accentuated in elderly patients (age ≥ 65 years), while there was no difference in all-cause mortality across the HbA1c groups in younger patients (age < 65 years).
Conclusions:
The less strict glycemic control in diabetic patients with AMI would be optimal for preventing mortality, especially in elderly patients.
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