Does glycemic control still matter in patients with DM at high CV risk?

  • Menon V & al.
  • J Am Heart Assoc
  • 7 Jan 2020

  • International Clinical Digest
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Takeaway

  • In a contemporary population of patients with diabetes mellitus (DM) and established coronary artery disease on optimum medical therapy, HbA1c independently predicted major adverse cardiac events (MACEs) in the ACCELERATE trial.

Why this matters

  • Recent trials have suggested that strict glucose regimens may not reduce cardiovascular (CV) risk in patients with diabetes.

Study design

  • Subanalysis from 8145 participants with diabetes in ACCELERATE.
  • Funding: Eli Lilly.

Key results

  • Increasing baseline HbA1c levels were strongly associated with primary composite MACE endpoint, including CV death, nonfatal myocardial infarction (MI), stroke, coronary revascularization, or hospitalization for unstable angina.
    • Kaplan-Meier estimates: 12.6% for HbA1c
  • HbA1c was also associated with:
    • The triple endpoint of CV death, nonfatal MI, and stroke: 7.8%-11.3% (P=.003); and
    • Individual endpoints:
      • Nonfatal MI: 3.1%-7.0% (P<.001>
      • Hospitalization for unstable angina: 2.3%-5.0% (P=.003); and
      • Need for coronary revascularization: 7.3%-11.1% (P=.001).
  • CV mortality (2.6%-4.3%; P=.21) and all-cause mortality (4.8%-5.9%; P=.21) rates were similar across baseline HbA1c levels.
  • In multivariable model, baseline HbA1c independently predicted the primary composite endpoint censored at 915 days: HR, 1.06 (P=.003).

Limitations

  • Post-hoc analysis, potential confounding.
  • Short follow-up.
  • No data on use of glucose-lowering medications that could affect CV outcomes.