Glycemic Variation and Cardiovascular Risk in the Veterans Affairs Diabetes Trial

Zhou, Jin; Schwenke, Dawn C.; Bahn, Gideon; Reaven, Peter D.

doi:10.2337/dc18-0548

Cited by 106 publications

(98 citation statements)

References 38 publications

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“…[30][31][32] The association of HbA1c variability with all-cause mortality in this study is consistent with most previous results 7,18,21,[26][27][28][29] ; however, one study did not find such an association. 25 The mechanism underlying this association remains unclear. High glycaemic variability is associated with a high risk of severe hypoglycaemia.…”

Section: T a B L E 1 Baseline Characteristics Of The Study Subjectsmentioning

confidence: 99%

“…Beck et al proposed that estimation of glycaemic control using HbA1c alone may not be accurate for some patients . Recently, the relationships of HbA1c variability with diabetic complications and mortality in patients with T2D have piqued research interest. A recent study reported that the association of mean HbA1c with all‐cause mortality disappeared after adjustments for HbA1c variability measures, suggesting that HbA1c minimally influences all‐cause mortality.…”

Section: Introductionmentioning

confidence: 99%

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Effect of mean HbA1c on the association of HbA1c variability and all‐cause mortality in patients with type 2 diabetes

Tseng

Chen

Huang

et al. 2020

Diabetes Obesity Metabolism

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Aim To evaluate the effect of mean HbA1c on the correlation between HbA1c variability and all‐cause mortality, and the risks associated with different levels of HbA1c and glycaemic control status in patients with type 2 diabetes. Materials and Methods Patients with type 2 diabetes and at least three HbA1c measurements within 12–24 months were included. HbA1c variability score, coefficient of variation (CV) and standard deviation (SD) were used to evaluate variability. A variability score of 50 was set as a cutoff to define low and high variability. Results A total of 4216 patients were included, of whom 1196 died during the observation period (11.1 ± 3.2 years). All‐cause mortality increased with HbA1c variability score and the quartiles of HbA1c CV and SD. The strength of this association was attenuated after adjustment for mean HbA1c, and the risks associated with HbA1c variability and glycaemic control status were similar. The highest associated risk was observed with an HbA1c variability score of >50 and mean HbA1c of ≥7.5%. Mortality risk was significantly higher with a mean HbA1c of ≤6.0% and >8.5% and of ≤6.0% and >8.0% for low and high HbA1c variability, respectively. Conclusions Mean HbA1c contributed to the correlation between HbA1c variability and all‐cause mortality. The risks associated with HbA1c variability and glycaemic control status were similar. The relationship between mean HbA1c and mortality presented a J‐shaped distribution for both low and high HbA1c variability.

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Section: T a B L E 1 Baseline Characteristics Of The Study Subjectsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of mean HbA1c on the association of HbA1c variability and all‐cause mortality in patients with type 2 diabetes

Tseng

Chen

Huang

et al. 2020

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

show abstract

“…For example variability in heart rate or blood pressure has been linked to CHF 7 and all‐cause mortality 7 . In addition, variability in blood glucose or cholesterol has been related to CHD, 8 AF 9 and all‐cause mortality 10 . While liver enzymes can also fluctuate during the course of life, to date, no study has investigated whether liver enzyme variability is a predictor of heart disease and mortality.…”

Section: Introductionmentioning

confidence: 99%

Liver enzyme variability and risk of heart disease and mortality: A nationwide population‐based study

Cho

Han

Lee

et al. 2020

Liver International

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Background & Aims:Liver enzymes, such as alanine aminotransferase (ALT), aspartate aminotransferase (AST) and γ-glutamyltransferase (GGT), have been suggested as surrogate markers of various cardiovascular diseases. However, previous studies assessed liver enzymes only once at baseline. We investigated the association between liver enzyme variability and the risk of mortality and cardiovascular outcomes in general population. Methods:A total of 6 496 271 subjects participating in ≥3 health examinations within the previous 5 years including the index year (2009-2010) were included. Variability was measured using variability independent of the mean. Cox proportional hazard models adjusting demographic factors, comorbidities, blood pressure, total cholesterol, glomerular filtration rate and baseline liver enzyme level were used.Results: During a median follow-up of 6 years, there were 106 413 deaths (1.6%), 53 385 myocardial infarctions (MI, 0.8%), 65 143 atrial fibrillations (AF, 1.0%) and 50 139 congestive heart failures (CHF, 0.7%). High variability in AST, ALT and GGT was associated with a higher risk for all-cause mortality, MI, AF and CHF. The degree of association was largest for GGT variability. For the highest quartile of GGT variability relative to the lowest quartile, the hazard ratios (95% confidence intervals) were 1.32 (1.28-1.35) for all-cause mortality, 1.16 (1.11-1.20) for MI, 1.28 (1.18-1.38) for AF and 1.25 (1.20-1.30) for CHF. These findings were consistent regardless of alcohol consumption, body mass index and degree of fatty liver. Sensitivity analysis also revealed similar results. Conclusions:Higher visit-to-visit variability of liver enzymes was an independent predictor of all-cause mortality and cardiovascular events. K E Y W O R D S alanine aminotransferase, aspartate aminotransferase, cardiovascular outcome, mortality, variability, γ-glutamyltransferase Handling Editor: Luca Valenti | 1293 CHO et al.

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“…Excess variability in glucose and HbA 1c levels that results from chronic fluctuations over time may indicate increased cardiovascular risk in the diabetic population, 11,12 although the possibility has been controversial. [12][13][14][15] Patients with established coronary artery disease (CAD) may be particularly susceptible to poor glucose control. The few studies of longitudinal HbA 1c variation in patients with diabetes and CAD have assessed a limited number of HbA 1c measures, had short follow-up, or were based on heterogeneous populations.…”

Section: Introductionmentioning

confidence: 99%

Association of Longitudinal Values of Glycated Hemoglobin With Cardiovascular Events in Patients With Type 2 Diabetes and Multivessel Coronary Artery Disease

et al. 2020

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IMPORTANCE Glycated hemoglobin (HbA 1c) values are used to guide glycemic control, but in patients with type 2 diabetes and multivessel coronary artery disease (CAD), the association of the longitudinal values of HbA 1c with cardiovascular outcomes is unclear. OBJECTIVE To assess whether longitudinal variation of HbA 1c is associated with cardiovascular events in long-term follow-up among patients with diabetes and multivessel CAD. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 888 patients with type 2 diabetes and multivessel CAD in the Medicine, Angioplasty, or Surgery Study (MASS) Registry of the

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Glycemic Variation and Cardiovascular Risk in the Veterans Affairs Diabetes Trial

Cited by 106 publications

References 38 publications

Effect of mean HbA1c on the association of HbA1c variability and all‐cause mortality in patients with type 2 diabetes

Effect of mean HbA1c on the association of HbA1c variability and all‐cause mortality in patients with type 2 diabetes

Liver enzyme variability and risk of heart disease and mortality: A nationwide population‐based study

Association of Longitudinal Values of Glycated Hemoglobin With Cardiovascular Events in Patients With Type 2 Diabetes and Multivessel Coronary Artery Disease

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