Contemporary risk estimates of three HbA_1cvariables in relation to heart failure following diagnosis of type 2 diabetes

Abstract

BackgroundWe evaluated the association between glycaemic control and the risk of heart failure (HF) in a contemporary cohort of persons followed after diagnosis of type 2 diabetes (T2D).Methods and resultsPersons with T2D diagnosed between 1998 and 2012 were retrieved from the Clinical Practice Research Data Link in the UK and followed from diagnosis until the event of HF, mortality, drop out from the database due to any other reason, or the end of the study on 1 July 2015. The association between each of three different haemoglobin A1C (HbA1c) metrics and HF was estimated using adjusted proportional hazard models. In the overall cohort (n=94 332), the increased risk for HF per 1% (10 mmol/mol) increase in HbA1c was 1.15 (95% CI 1.13 to 1.18) for updated mean HbA1c, and 1.06 (1.04 to 1.07) and 1.06 (1.04 to 1.08) for baseline HbA1c and updated latest HbA1c, respectively. When categorised, the hazard risk (HR) for the updated mean HbA1c in relation to HF became higher than for baseline and updated latest HbA1c above HbA1c levels of 9%, but did not differ at lower HbA1c levels. The updated latest variable showed an increased risk for HbA1c <6% (42 mmol/mol) of 1.16 (1.07 to 1.25), relative category 6–7%, while the HRs for updated mean and baseline HbA1c showed no such J-shaped pattern.ConclusionsHyperglycaemia is still a risk factor for HF in persons with T2D of similar magnitude as in earlier cohorts. Such a relationship exists for current glycaemic levels, at diagnosis and the overall level but the pattern differs for these variables.

Aggregated Tau Measured by Visual Interpretation of Flortaucipir Positron Emission Tomography and the Associated Risk of Clinical Progression of Mild Cognitive Impairment and Alzheimer Disease

“…Clinical mod- els of cardiovascular risk assessment demonstrated similar modest levels of risk prediction. [32][33][34][35] Therefore, despite relatively modest effect size, flortaucipir scan patterns may provide clinically relevant prognostic information for AD patient management. Although statistical significance was not met for all tests, data for each study similarly showed that the advanced AD pattern group was at an increased risk of clinical progression.…”

An in-depth analysis of glycosylated haemoglobin level, body mass index and left ventricular diastolic dysfunction in patients with type 2 diabetes

“…This is partly because all the major risk factors for heart failure can present in patients with type 2 diabetes such as obesity, hypertension, advanced age, sleep apnoea, dyslipidaemia, anemia, chronic kidney disease, and coronary heart disease [15]. Hyperglycaemia is a risk factor for heart failure in persons with type 2 diabetes [16]. Excess body weight, is also a major risk factor for cardiovascular disease [17].…”

Heartbeat: Diabetes and heart failure

“…In this issue of Heart , Skrtic and colleagues1 evaluated data from over 94 thousand primary care patients with type 2 diabetes (T2D) in the Clinical Practice Research Data Link to study the relationship between incident heart failure (HF) and hemoglobin A1c (HbA1c) levels at the initial diagnosis (baseline), most recent visit (updated latest) and an updated mean level. As shown in figure 1, elevations in all 3 HbA1c levels were associated with a higher hazard ratio  for HF, with the strongest association seen for the updated mean value.…”