Voice of the Diabetic

Voice of the Diabetic

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HEART RISKS TIED TO GLYCEMIC CONTROL

Evidence continues to mount that poor glycemic control is associated

with an increased risk of heart failure among adult diabetics. Researchers from

Kaiser Permanente, in Oakland, California, recently examined the link between

hemoglobin (Hb)A1c level and risk of serious heart complications in a large

sample of young adult diabetics.

Was there a statistical association? Did it differ by patient

sex, heart failure pathogenesis or hypertension status? The study ran from January

1, 1995 to June 30, 1996, with a follow-up through December 31, 1997, and median

follow-up was 2.2 years. Study participants were 25,958 young men and 22,900

women with predominantly type 2 diabetes, and no known history of heart failure.

A total of 935 cardiac events occurred, 516 among men and 491 among women. Each

1 percent increase in HbA1c (one full A1c number higher) was found to be associated

with an eight percent increased risk of heart failure. A range of factors was

taken into account, including age, sex, race/ethnicity, education, cigarette

smoking, alcohol use, hypertension, obesity, use of beta-blockers and angiotensin

converting enzyme (ACE) inhibitors, type and duration of diabetes and incidence

of interim myocardial infarction.

An HbA1c of 10, relative to the non-diabetic “normal”

HbA1c of less than seven, was associated with a 1.56-fold greater risk of heart

failure. The association was found to be stronger in men than in women. However,

there were no differences by heart failure pathogenesis or hypertension status.

These findings confirm previous evidence that poor glycemic

control may be linked with increased risk of heart failure among diabetic adults,

study authors conclude.

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