- In patients with diabetes mellitus (DM) and stable ischemic heart disease (SIHD), lifestyle factors and HbA1c
Why this matters
- Relevance of HbA1c to survival in DM with SIHD is controversial.
- 592 patients with DM and SIHD in the COURAGE trial, with complete ascertainment of 7 prespecified risk factors at baseline and after 1 year:
- systolic BP, low-density lipoprotein cholesterol, not smoking, moderate physical activity ≥5x/week, American Heart Association Step 2 diet adherence, BMI, HbA1c.
- Mean follow-up, 7.0 years beyond 1 year postrandomization, during which 31.4% died (n=186).
- Funding: US Department of Veterans Affairs; Canadian Institutes of Health Research; Merck & Co., Inc., Kenilworth, NJ, USA; Pfizer; others.
- Survival (%) increased with number of goals met (overall P=.002):
- 33% with 0-1 goals met,
- 57% with 2 (P=.09),
- 61% with 3 (P=.02),
- 71% with 4 (P=.003),
- 80% with 5 (P<.001 and>
- 82% with 6-7 goals met (P<.001>
- Not smoking: 0.49 (P=.02);
- Physical activity: 0.60 (P=.007);
- Dietary adherence: 0.60 (P=.02); and
- Possible residual confounding.
- Risk factor changes not measured beyond 1 year.