Rationale for glycemic control to improve cardiovascular outcome: Lessons from east and west
Year: 2021
Type: article
Abstract: Rationale for glycemic control to improve cardiovascular outcome: Lessons from east and west It is clear that there is a strong relationship between diabetes and cardiovascular disease (CVD).Both for men and for women, diabetes confers the highest lifetime risk for coronary arterial disease (CAD) as a single independent risk factor. 1 In a metaanalysis of 102 prospective studies of more than 500 000 persons, there was a doubling of risk both of CAD and stroke associated with diabetes, adjusted for age, cigarette use, obesity, hypertension, and sex. 2 Further analysis from this group of a larger cohort of nearly 700 000 persons showed that diabetes, a history of myocardial infarction (MI), and a history of stroke were associated with similar mortality.The presence of any two of these factors led to a doubling of risk, and the presence of all three to a doubling again for mortality risk.3 Although the Swedish National Diabetes Register showed progressive reduction in CVD from 1998 through 2014 among persons both with and without diabetes, the gap in CVD death and hospitalization rates between the groups persisted throughout the period.4 Diabetes is characterized by persistent elevation in blood glucose levels.As such, it is reasonable to postulate that greater glycemic exposure is associated with greater levels of risk of complications.Indeed, in a cohort of persons representative of the US population varying from euglycemia to prediabetes to diabetes with progressively higher HbA1c levels followed from 1998 through 2011, CVD mortality increased by 25% with HbA1c 8%-8.9% compared with HbA1c of 7%-8% and by another 25% with HbA1c of 9% or more.5 In the Swedish National Diabetes Register diabetes cohort of more than 250 000 persons, mortality, MI, stroke, and heart failure increased progressively with rising HbA1c with marked increase as HbA1c rose from 7% to 9%.6 In a further study by this group using an expanded cohort of more than 400 000 persons with diabetes, over a 7-year period, the stroke rates in persons with HbA1c 7.1%-8%, 8.1%-9%, 9.1%-10%, and >10% were 1.27-, 1.68-, 1.89-, and 2.14-fold greater than that in matched persons without diabetes.7 Is there then evidence from trials showing that CVD outcomes improve with glycemic control in persons with diabetes?The evidence here is complex.In a metaanalysis
Source: Journal of Diabetes
Authors: Zachary Bloomgarden, Juliana C. N. Chan
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W3165693622