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Cardiovascular and Metabolic Risk
ASCVD risk stratification modifies the effect of HbA1c on cardiovascular events among patients with type 2 diabetes mellitus with basic to moderate risk
  1. Hongmei Zhang1,
  2. Li Qin2,
  3. Chang-Sheng Sheng3,
  4. Yixin Niu1,
  5. Hongxia Gu2,
  6. Shuai Lu2,
  7. Zhen Yang1,
  8. Jingyan Tian4,
  9. Qing Su1
  1. 1 Department of Endocrinology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
  2. 2 Department of Endocrinology, Chongming Branch, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
  3. 3 Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
  4. 4 State Key Laboratory of Medical Genomics, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrinology and Metabolism, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
  1. Correspondence to Dr Jingyan Tian; tianjypaper{at}163.com; Dr Qing Su; suqing{at}xinhuamed.com.cn

Abstract

Objective To investigate the association between hemoglobin A1c (HbA1c) 7.0%–8.0% and cardiovascular disease (CVD) risk among Chinese patients with type 2 diabetes mellitus (T2DM) with different baseline 10-year atherosclerotic CVD (ASCVD) risk stratification.

Research design and methods A prospective population-based cohort of 10 060 adults aged 40–70 years in Chongming District of Shanghai was established in 2011. These participants were followed up for 3.25 years and CVD information was recorded. We investigated this association between HbA1c categories and incident CVD stratified by the 10-year ASCVD risk using multiple Cox regression analysis among 1880 patients with T2DM without CVD history. CVD events were defined as cardiovascular death, non-fatal myocardial infarction or non-fatal stroke.

Results The corresponding incidence of CVD per 1000 person-years for the HbA1c≤6.5%, 6.6%–6.9%, 7.0%–8.0% and >8.0% groups were 12.5, 21.8, 22.9 and 28.9, respectively. The HbA1c>8.0% group was significantly associated with a higher CVD risk in patients with T2DM. The HbA1c 7.0%–8.0% group was significantly associated with a higher CVD risk in patients with T2DM with moderate baseline ASCVD risk (HR 2.48; 95% CI 1.15 to 5.32).

Conclusion HbA1c of 7.0%–8.0% may result in a significantly higher CVD risk among patients with T2DM with moderate baseline ASCVD risk, which support the use of HbA1c combined with baseline ASCVD risk assessment to determine future glucose-lowering treatment decisions among patients with T2DM with basic to moderate risk.

  • HbA1c
  • cardiovascular risk assessment
  • CVD
  • CVD risk factors
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjdrc-2019-000810

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    Footnotes

    • HZ, LQ and C-SS contributed equally.

    • Contributors JT and QS contributed to the conception or design of the work. HZ, LQ, YN, HG, SL, ZY, JT, C-SS and QS contributed to the acquisition, analysis or interpretation of data for the work. JT, HZ and C-SS drafted the manuscript. QS critically revised the manuscript. All gave final approval and agreed to be accountable for all aspects of work ensuring integrity and accuracy.

    • Funding This work was supported by Shanghai Science and Technology Commission Key Program (10411956600, 15411953200), Shanghai Pujiang Talents Plan (18PJ1407200), Research Project Funded by the Shanghai Municipal Health Bureau (20114301), National Natural Science Foundation of China (81670743, 81770418 and 81270935) and National Key R&D Program of China (2016YFC1300103, 2016YFC0901200, 2016YFC0901203 and 2016YFC0905001).

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The study protocol was approved by the institutional review board of Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.