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Association between glycated haemoglobin levels and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease: a secondary analysis of the TECOS randomized clinical trial
Author(s) -
McAlister Finlay A.,
Zheng Yinggan,
Westerhout Cynthia M.,
Buse John B.,
Standl Eberhard,
McGuire Darren K.,
Van de Werf Frans,
Green Jennifer B.,
Armstrong Paul W.,
Holman Rury R.
Publication year - 2020
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.1958
Subject(s) - medicine , hazard ratio , interquartile range , heart failure , myocardial infarction , diabetes mellitus , unstable angina , cardiology , type 2 diabetes , sitagliptin , stroke (engine) , randomized controlled trial , proportional hazards model , confidence interval , endocrinology , mechanical engineering , engineering
Aims Whether glycaemic control is associated with cardiovascular outcomes in patients with type 2 diabetes (T2D) is unclear. Consequently, we assessed the relationship between glycated haemoglobin (HbA 1c ) and cardiovascular outcomes in a placebo‐controlled randomized trial which demonstrated no cardiovascular effect of sitagliptin in patients with T2D and atherosclerotic vascular disease. Methods and results Secondary analysis of 14 656 TECOS participants with time to event analyses using multivariable Cox proportional hazard models. During a median 3.0 (interquartile range 2.3–3.8) year follow‐up, 456 (3.1% of 14 656) patients had first hospitalization for heart failure (HF), 1084 (11.5%) died, 1406 (9.6%) died or were hospitalized for HF, and 1689 (11.5%) had a non‐HF cardiovascular event (cardiovascular death, non‐fatal stroke, non‐fatal myocardial infarction, or hospitalization for unstable angina). Associations between baseline or time‐varying HbA 1c and cardiovascular outcomes were U‐shaped, with the lowest risk when HbA 1c was around 7%. Each one‐unit increase in the time‐varying HbA 1c above 7% was associated with an adjusted hazard ratio (HR) of 1.21 [95% confidence interval (CI) 1.11–1.33] for first HF hospitalization, 1.11 (1.03–1.21) for all‐cause death, 1.18 (1.09–1.26) for death or HF hospitalization, and 1.10 (1.02–1.17) for non‐HF cardiovascular events. Each one‐unit decrease in the time‐varying HbA 1c below 7% was associated with an adjusted HR of 1.35 (95% CI 1.12–1.64) for first HF hospitalization, 1.37 (1.16–1.61) for death, 1.42 (1.23–1.64) for death or HF hospitalization, and 1.22 (1.06–1.41) for non‐HF cardiovascular events. Conclusion Glycated haemogobin exhibits a U‐shaped association with cardiovascular outcomes in patients with T2D and atherosclerotic vascular disease, with nadir around 7%. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT00790205.