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HbA1c, Coronary atheroma progression and cardiovascular outcomes

Iryna Dykun1,2, Ozgur Bayturan3, Julie Carlo1

  • 1C5Research, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH.

American Journal of Preventive Cardiology
|February 3, 2022
PubMed

Insights

Higher on-treatment hemoglobin A1c (HbA1c) levels are linked to increased coronary artery plaque buildup and major adverse cardiovascular events (MACE). This suggests glycemic control directly impacts cardiovascular health, independent of other risk factors.

Area of Science:

  • Cardiology
  • Endocrinology
  • Metabolic Syndrome

Background:

  • Glycemic control is crucial for managing diabetes and preventing complications.
  • The direct impact of on-treatment hemoglobin A1c (HbA1c) on coronary atheroma progression and major adverse cardiovascular events (MACE) remains an area of investigation.

Purpose of the Study:

  • To investigate the independent association between on-treatment HbA1c levels and coronary atheroma progression.
  • To assess the relationship between on-treatment HbA1c levels and the incidence of MACE.

Main Methods:

  • A post-hoc pooled analysis of seven prospective, randomized trials using serial coronary intravascular ultrasonography (IVUS).
  • Percent atheroma volume (PAV) was measured to assess plaque burden.
  • Multivariable mixed modeling and Cox proportional hazard models were employed to analyze associations.

Main Results:

  • In 3,312 patients, higher on-treatment HbA1c levels were independently associated with increased annualized changes in PAV (beta: 0.13 [0.08, 0.19], p < 0.001).
  • On-treatment HbA1c levels were also independently associated with a higher incidence of MACE (HR: 1.13 [1.04, 1.23], p = 0.005).

Conclusions:

  • Elevated on-treatment HbA1c levels are significantly associated with coronary atheroma progression and adverse cardiovascular outcomes, irrespective of other risk factor control.
  • These findings support a direct effect of glycemic control on coronary atheroma and atherosclerotic events, underscoring the rationale for therapies targeting glycemic modulation.
Abstract

Keywords:
ACS, acute coronary syndromeAQUARIUS, Aliskiren Quantative Atherosclerosis Regression Intravascular Ultrasound StudyASCVD, atherosclerotic cardiovascular diseaseBMI, body mass indexCVD, cardiovascular diseaseCoronary atheroma progressionDiabetes mellitusGLAGOV, Global Assessment of Plaque Regression With a PCSK9 Antibody as Measured by Intravascular UltrasoundHDL-C, high-density lipoprotein cholesterolHbA1cHbA1c, hemoglobin A1cIBIS 2, The Integrated Biomarkers and Imaging Study-2IVUSIVUS, intravascular ultrasonographyLDL-C, lipoprotein cholesterolMACEMACE, major adverse cardiovascular eventsNORMALISE, Norvasc for Regression of Manifest Atherosclerotic Lesions by Intravascular Sonographic EvaluationPAV, percent atheroma volumePERISCOPE, Pioglitazone Effect on Regression of Intravascular Sonographic Coronary Obstruction Prospective EvaluationPVD, peripheral vascular diseaseREVERSAL, Reversal of Atherosclerosis With Aggressive Lipid LoweringSATURN, The Study of Coronary Atheroma by Intravascular Ultrasound: Effect of Rosuvastatin Versus AtorvastatinSTRADIVARIUS, Strategy to Reduce Atherosclerosis Development Involving Administration of Rimonabont – The Intravascular Ultrasound StudyTG, triglyceridesUKPDS, UK Prospective Diabetes StudyhsCRP, high-sensitivity-CRP

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