(07-01-14) HbA1c and Heart Failure Risk among Diabetic Patients.

Zhao W, Katzmarzyk PT, Horswell R, Wang Y, Johnson J, Hu G.
Source
Pennington Biomedical Research Center, Baton Rouge, LA; Louisiana State University Health Science Center, New Orleans, LA.
Abstract
Context:Diabetes is an independent risk factor for heart failure (HF), however, it is not known if tight glycemic control can reduce the occurrence of HF among diabetic patients.Objective:To investigate the race-specific association of different levels of HbA1c with the risk of HF among patients with diabetes.Design, setting, and participants:We prospectively investigated the race-specific association of different levels of HbA1c at baseline and during an average of 6.5 years of follow-up with incident HF risk among 17,181 African American and 12,446 White diabetic patients within the Louisiana State University (LSU) Hospital System.Main Outcome Measure:Incident HF until May 31, 2012.Results:During follow up, 5,089 HF incident cases were identified. The multivariable-adjusted hazard ratios (HRs) of HF associated with different levels of HbA1c at baseline (<6.0% [reference group], 6.0-6.9%, 7.0-7.9%, 8.0-8.9%, 9.0-9.9%, and ¡Ý10.0%,) were 1.00, 1.02 (95% confidence interval [CI] 0.91-1.15), 1.21 (1.05-1.38), 1.29 (1.12-1.50), 1.37 (1.17-1.61), and 1.49 (1.31-1.69) (P trend <0.001) for African American diabetic patients, and 1.00, 1.09 (0.96-1.22), 1.09 (0.95-1.26), 1.43 (1.22-1.67), 1.49 (1.25-1.77), and 1.61 (1.38-1.87) (P trend <0.001) for white diabetic patients, respectively. This graded positive association was also present in diabetic patients with and without glucose-lowering agent treatment, and in diabetic patients with different age, gender, smoking status, and in incident HF defined as systolic HF (ejection fraction ¡Ü40%) and HF with a preserved ejection fraction (ejection fraction >40%).Conclusions:The current study suggests a graded positive association of HbA1c with the risk of HF among both African American and white patients with diabetes.

Source: J Clin Endocrinol Metab. 2013 Dec 2. [Epub ahead of print]

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