T2DM: ASCVD risk stratification modifies the impact of HbA1c on CV events


  • Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In patients with type 2 diabetes mellitus (T2DM), glycated haemoglobin (HbA1c) of 7.0-8.0% along with moderate baseline atherosclerotic cardiovascular disease (ASCVD) risk was significantly associated with a higher risk for CVD.

Why this matters

  • Findings support the use of HbA1c combined with baseline ASCVD risk assessment to determine the future glucose-lowering treatment in patients with T2DM with basic-to-moderate risk.

Study design

  • A prospective cohort study of 1880 patients with T2DM and without CVD history.
  • All patients followed up for 3.25 years and evaluated for CVD events (CV death, non-fatal myocardial infarction and non-fatal stroke).
  • Funding: Shanghai Science and Technology Commission Key Program and others.

Key results

  • During the follow-up, the incidence of CVD per 1000 person-years was 12.5, 21.8, 22.9 and 28.9 in patients with T2DM for HbA1c of ≤6.5%, 6.6-6.9%, 7.0-8.0%, and >8.0%, respectively.
  • In patients with T2DM and with moderate baseline ASCVD risk, HbA1c of 7.0-8.0% was associated with an increased risk for CVD (HR, 2.48; 95% CI, 1.15-5.32; P=.02).
  • HbA1c >8.0% level was significantly associated with a higher risk for CVD in patients with T2DM and with:
    • basic ASCVD risk (HR, 2.11; 95% CI, 1.11-4.02; P=.02) and
    • moderate ASCVD risk (HR, 3.34; 95% CI, 1.60-6.97; P=.00).

Limitations

  • Short-term follow-up.