Lifestyle, HbA1c predict survival in patients with DM and stable IHD

  • J Am Coll Cardiol

  • International Clinical Digest
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Takeaway

  • 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.

Study design

  • 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.

Key results

  • 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>
  • In multivariate analysis, strongest predictors of survival were (HRs):
    • Not smoking: 0.49 (P=.02);
    • Physical activity: 0.60 (P=.007); 
    • Dietary adherence: 0.60 (P=.02); and
    • HbA1c

Limitations

  • Possible residual confounding.
  • Risk factor changes not measured beyond 1 year.