Work

The Association Between HbA1c Levels and the Risk of Myocardial Infarction and Stroke in People with Type 2 Diabetes: A Post Hoc Analysis of the REPRESENT Study

Year: 2025

Type: article

Abstract: The aim of this work was to analyze the association between baseline glycated hemoglobin (HbA1c) levels and other factors on the risk of first myocardial infarction (MI) and on the risk of first stroke in people with type 2 diabetes (T2D) in Spain. This post hoc analysis of the REPRESENT study used the IQVIA electronic medical records database. Cumulative incidences were estimated using the Kaplan–Meier method, and Cox regression models were used to identify associated risk factors, including gender, age, HbA1c, or prior cardiovascular disease (other than MI/stroke). Median follow-up was 7 years. In people without prior MI/stroke, the incidence (95% confidence interval [CI]) of first MI/stroke was 0.31 (0.28–0.34) and 0.18 (0.15–0.20) events per 100 patient-years, respectively. Baseline HbA1c levels < 6.5% were independently associated with lower risk of first MI (hazard ratio [HR] 0.76 [95% CI 0.61–0.94]) and of first stroke (HR 0.74 [95% CI 0.56–0.98]). Male sex, age ≥ 50 years, and previous cardiovascular disease were independently associated with a higher risk of MI/stroke. This analysis found an association between baseline HbA1c levels < 6.5% and lower risk of a first MI or stroke in a T2D cohort in Spain, suggesting a role of stringent glycemic control in the prevention of cardiovascular complications. People with type 2 diabetes (T2D) are known to have a greater risk of cardiovascular disease, including heart attacks (also known as myocardial infarctions [MIs]) and strokes, than people without T2D. The REPRESENT study looked at the rates of first MI/stroke over a 7-year period in a group of Spanish people with T2D and analyzed the relationship between the risk of first MI/stroke and low blood sugar levels at the start of the study, as well as other factors such as age, sex, and previous cardiovascular disease. Blood sugar levels were measured using glycated hemoglobin (HbA1c), and stringent glycemic control, was defined by an HbA1c of < 6.5%. Hb1c levels < 6.5% at the start of the study were associated with a decrease in the risk of a first MI and a decrease in the risk of first stroke. Men, those aged 50 years or older, and those with previous cardiovascular disease had an increased risk of first MI or stroke compared with women, those aged < 50 years and those without previous cardiovascular disease. The results of this analysis of people with T2D in Spain suggest that HbA1c of < 6.5% have a role to play in preventing heart-related complications in people with T2D.

Source: Diabetes Therapy

DOI: 10.1007/s13300-025-01727-6