Relationship between HbA1c levels and risk of cardiovascular adverse outcomes and all-cause mortality in overweight and obese cardiovascular high-risk women and men with type 2 diabetes

TY - JOUR

T1 - Relationship between HbA1c levels and risk of cardiovascular adverse outcomes and all-cause mortality in overweight and obese cardiovascular high-risk women and men with type 2 diabetes

AU - Andersson, C

AU - van Gaal, L

AU - Caterson, I D

AU - Weeke, P

AU - James, W P T

AU - Couthino, W

AU - Finer, Nicholas

AU - Sharma, A M

AU - Maggioni, A P

AU - Torp-Pedersen, C

PY - 2012/9

Y1 - 2012/9

N2 - Aims/hypothesis: The optimal HbA1c concentration for prevention of macrovascular complications and deaths in obese cardiovascular high-risk patients with type 2 diabetes remains to be established and was therefore studied in this post hoc analysis of the Sibutramine Cardiovascular OUTcomes (SCOUT) trial, which enrolled overweight and obese patients with type 2 diabetes and/or cardiovascular disease. Methods: HRs for meeting the primary endpoint (nonfatal myocardial infarction, nonfatal stroke, resuscitated cardiac arrest or cardiovascular death) and all-cause mortality were analysed using Cox regression models. Results: Of 8,252 patients with type 2 diabetes included in SCOUT, 7,479 had measurements of HbA1c available at baseline (i.e. study randomisation). Median age was 62 years (range 51-86 years), median BMI was 34.0 kg/m2 (24.8-65.1 kg/m2) and 44% were women. The median HbA1c concentration was 7.2% (3.8-15.9%) (55 mmol/l [18-150 mmol/l]) and median diabetes duration was 7 years (0-57 years). For each 1 percentage point HbA1c increase, the adjusted HR for the primary endpoint was 1.17 (95% CI 1.11, 1.23); no differential sex effect was observed (p = 0.12 for interaction). In contrast, the risk of all-cause mortality was found to be greater in women than in men: HR 1.22 (1.10, 1.34) vs 1.12 (1.04, 1.20) for each 1 percentage point HbA1c increase (p = 0.02 for interaction). There was no evidence of increased risk associated with HbA 1c ≤6.4% (≤46 mmol/l). Glucose-lowering treatment regimens, diabetes duration or a history of cardiovascular disease did not modify the associations. Conclusions/interpretation: In overweight, cardiovascular high-risk patients with type 2 diabetes, increasing HbA1c concentrations were associated with increasing risks of cardiovascular adverse outcomes and all-cause mortality.

AB - Aims/hypothesis: The optimal HbA1c concentration for prevention of macrovascular complications and deaths in obese cardiovascular high-risk patients with type 2 diabetes remains to be established and was therefore studied in this post hoc analysis of the Sibutramine Cardiovascular OUTcomes (SCOUT) trial, which enrolled overweight and obese patients with type 2 diabetes and/or cardiovascular disease. Methods: HRs for meeting the primary endpoint (nonfatal myocardial infarction, nonfatal stroke, resuscitated cardiac arrest or cardiovascular death) and all-cause mortality were analysed using Cox regression models. Results: Of 8,252 patients with type 2 diabetes included in SCOUT, 7,479 had measurements of HbA1c available at baseline (i.e. study randomisation). Median age was 62 years (range 51-86 years), median BMI was 34.0 kg/m2 (24.8-65.1 kg/m2) and 44% were women. The median HbA1c concentration was 7.2% (3.8-15.9%) (55 mmol/l [18-150 mmol/l]) and median diabetes duration was 7 years (0-57 years). For each 1 percentage point HbA1c increase, the adjusted HR for the primary endpoint was 1.17 (95% CI 1.11, 1.23); no differential sex effect was observed (p = 0.12 for interaction). In contrast, the risk of all-cause mortality was found to be greater in women than in men: HR 1.22 (1.10, 1.34) vs 1.12 (1.04, 1.20) for each 1 percentage point HbA1c increase (p = 0.02 for interaction). There was no evidence of increased risk associated with HbA 1c ≤6.4% (≤46 mmol/l). Glucose-lowering treatment regimens, diabetes duration or a history of cardiovascular disease did not modify the associations. Conclusions/interpretation: In overweight, cardiovascular high-risk patients with type 2 diabetes, increasing HbA1c concentrations were associated with increasing risks of cardiovascular adverse outcomes and all-cause mortality.

U2 - 10.1007/s00125-012-2584-3

DO - 10.1007/s00125-012-2584-3

M3 - Journal article

SN - 0012-186X

VL - 55

SP - 2348

EP - 2355

JO - Diabetologia

JF - Diabetologia

IS - 9

ER -