Sridharan Raghavan1, Wenhui G Liu2, P Michael Ho3, Mary E Plomondon2, Anna E Barón2, Liron Caplan4, Karen E Joynt Maddox5, David Magid2, David R Saxon6, Corrine I Voils7, Steven M Bradley8, Thomas M Maddox9. 1. Veterans Affairs Eastern Colorado Healthcare System, Denver, CO, United States; Division of General Internal Medicine, University of Colorado School of Medicine, Denver, CO, United States. Electronic address: sridharan.raghavan@ucdenver.edu. 2. Veterans Affairs Eastern Colorado Healthcare System, Denver, CO, United States. 3. Veterans Affairs Eastern Colorado Healthcare System, Denver, CO, United States; Division of Cardiology, University of Colorado School of Medicine, Denver, CO, United States. 4. Veterans Affairs Eastern Colorado Healthcare System, Denver, CO, United States; Division of Rheumatology, University of Colorado School of Medicine, Denver, CO, United States. 5. Division of Cardiology, Washington University School of Medicine, St. Louis, MO, United States. 6. Veterans Affairs Eastern Colorado Healthcare System, Denver, CO, United States; Division of Endocrinology, University of Colorado School of Medicine, Denver, CO, United States. 7. William S. Middleton Veterans Memorial Hospital, Madison, WI, United States; Department of Surgery, University of Wisconsin School of Medicine, Madison, WI, United States. 8. Minneapolis Heart Institute, Minneapolis, MN(1), United States. 9. Veterans Affairs Eastern Colorado Healthcare System, Denver, CO, United States; Division of Cardiology, Washington University School of Medicine, St. Louis, MO, United States.
Abstract
AIMS: This study examined whether the association between hemoglobin A1c (HbA1c) and short-term clinical outcomes is moderated by CAD severity. METHODS: We studied 17,394 US Veterans with type 2 diabetes who underwent elective cardiac catheterization between 2005 and 2013. CAD severity was categorized as obstructive, non-obstructive, or no CAD. Using multivariable Cox proportional hazards regression, we assessed associations between time-varying HbA1c and two-year all-cause mortality and non-fatal MI, with an interaction term between HbA1c and CAD severity. RESULTS: 61%, 22%, and 17% of participants had obstructive, non-obstructive, and no CAD, respectively. CAD severity modified the relationship between HbA1c and each outcome (interaction p-value 0.0005 for mortality and <0.0001 for MI). Low HbA1c (<42 mmol/mol) was associated with increased mortality, relative to HbA1c of 48-52 mmol/mol, in individuals with obstructive CAD (HR 1.52 [1.17, 1.97]) and non-obstructive CAD (HR 2.61 [1.61, 4.23]), but not in those with no CAD (HR 0.91 [0.46, 1.79]). In contrast, higher HbA1c levels (≥53 mmol/mol) were associated with increased MI risk only in individuals with obstructive CAD. CONCLUSIONS: The associations between HbA1c and mortality and MI were moderated by CAD severity. Measures of cardiovascular disease severity may inform optimal individualized diabetes management.
AIMS: This study examined whether the association between hemoglobin A1c (HbA1c) and short-term clinical outcomes is moderated by CAD severity. METHODS: We studied 17,394 US Veterans with type 2 diabetes who underwent elective cardiac catheterization between 2005 and 2013. CAD severity was categorized as obstructive, non-obstructive, or no CAD. Using multivariable Cox proportional hazards regression, we assessed associations between time-varying HbA1c and two-year all-cause mortality and non-fatal MI, with an interaction term between HbA1c and CAD severity. RESULTS: 61%, 22%, and 17% of participants had obstructive, non-obstructive, and no CAD, respectively. CAD severity modified the relationship between HbA1c and each outcome (interaction p-value 0.0005 for mortality and <0.0001 for MI). Low HbA1c (<42 mmol/mol) was associated with increased mortality, relative to HbA1c of 48-52 mmol/mol, in individuals with obstructive CAD (HR 1.52 [1.17, 1.97]) and non-obstructive CAD (HR 2.61 [1.61, 4.23]), but not in those with no CAD (HR 0.91 [0.46, 1.79]). In contrast, higher HbA1c levels (≥53 mmol/mol) were associated with increased MI risk only in individuals with obstructive CAD. CONCLUSIONS: The associations between HbA1c and mortality and MI were moderated by CAD severity. Measures of cardiovascular disease severity may inform optimal individualized diabetes management.
Authors: Thomas M Maddox; Maggie A Stanislawski; Gary K Grunwald; Steven M Bradley; P Michael Ho; Thomas T Tsai; Manesh R Patel; Amneet Sandhu; Javier Valle; David J Magid; Benjamin Leon; Deepak L Bhatt; Stephan D Fihn; John S Rumsfeld Journal: JAMA Date: 2014-11-05 Impact factor: 56.272
Authors: Silvio E Inzucchi; Richard M Bergenstal; John B Buse; Michaela Diamant; Ele Ferrannini; Michael Nauck; Anne L Peters; Apostolos Tsapas; Richard Wender; David R Matthews Journal: Diabetes Care Date: 2015-01 Impact factor: 19.112
Authors: Elizabeth Selvin; Spyridon Marinopoulos; Gail Berkenblit; Tejal Rami; Frederick L Brancati; Neil R Powe; Sherita Hill Golden Journal: Ann Intern Med Date: 2004-09-21 Impact factor: 25.391
Authors: P Michael Ho; Anne Lambert-Kerzner; Evan P Carey; Ibrahim E Fahdi; Chris L Bryson; S Dee Melnyk; Hayden B Bosworth; Tiffany Radcliff; Ryan Davis; Howard Mun; Jennifer Weaver; Casey Barnett; Anna Barón; Eric J Del Giacco Journal: JAMA Intern Med Date: 2014-02-01 Impact factor: 21.873
Authors: Sophia Zoungas; John Chalmers; Bruce Neal; Laurent Billot; Qiang Li; Yoichiro Hirakawa; Hisatomi Arima; Helen Monaghan; Rohina Joshi; Stephen Colagiuri; Mark E Cooper; Paul Glasziou; Diederick Grobbee; Pavel Hamet; Stephen Harrap; Simon Heller; Liu Lisheng; Giuseppe Mancia; Michel Marre; David R Matthews; Carl E Mogensen; Vlado Perkovic; Neil Poulter; Anthony Rodgers; Bryan Williams; Stephen MacMahon; Anushka Patel; Mark Woodward Journal: N Engl J Med Date: 2014-09-19 Impact factor: 91.245
Authors: Alexandra K Lee; Bethany Warren; Clare J Lee; John W McEvoy; Kunihiro Matsushita; Elbert S Huang; A Richey Sharrett; Josef Coresh; Elizabeth Selvin Journal: Diabetes Care Date: 2017-11-10 Impact factor: 19.112
Authors: Kylie E Adamek; Deepa Ramadurai; Elise Gunzburger; Mary E Plomondon; P Michael Ho; Sridharan Raghavan Journal: J Am Heart Assoc Date: 2019-02-05 Impact factor: 5.501
Authors: Sridharan Raghavan; Wenhui G Liu; Seth A Berkowitz; Anna E Barón; Mary E Plomondon; Thomas M Maddox; Jane E B Reusch; P Michael Ho; Liron Caplan Journal: J Gen Intern Med Date: 2020-04-24 Impact factor: 5.128