Coronary artery disease severity modifies associations between glycemic control and both mortality and myocardial infarction

Sridharan Raghavan, Wenhui G. Liu, P. Michael Ho, Mary E. Plomondon, Anna E. Barón, Liron Caplan, Karen E. Joynt Maddox, David Magid, David R. Saxon, Corrine I. Voils, Steven M. Bradley, Thomas M. Maddox

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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.

Original languageEnglish
Pages (from-to)480-487
Number of pages8
JournalJournal of Diabetes and Its Complications
Volume32
Issue number5
DOIs
StatePublished - May 2018

Keywords

  • Cardiovascular risk factor
  • Coronary artery disease
  • Glycemic control
  • Heart disease
  • Interaction

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    Raghavan, S., Liu, W. G., Michael Ho, P., Plomondon, M. E., Barón, A. E., Caplan, L., Joynt Maddox, K. E., Magid, D., Saxon, D. R., Voils, C. I., Bradley, S. M., & Maddox, T. M. (2018). Coronary artery disease severity modifies associations between glycemic control and both mortality and myocardial infarction. Journal of Diabetes and Its Complications, 32(5), 480-487. https://doi.org/10.1016/j.jdiacomp.2018.01.010