Abstract
Background: Large epidemiologic studies have established diabetes mellitus as an independent risk factor for all-cause mortality. There is also evidence to suggest a linear relationship between hemoglobin A1c (HbA1c) and mortality. We find that poorly controlled diabetes in high-risk US Veterans carries an independent mortality risk mediated through reduced ejection fraction (rEF) and obstructive coronary artery disease (ObCAD). Methods: 1535 consecutive US Veterans presenting for left heart catheterization were retrospectively analyzed for presence of risk factors with long-term follow-up. Results: 248 patients had HbA1c ≥8 with 76.2% mortality compared to 198 patients with HbA1c in the prediabetic range of 5.70-6.49 with 67.2% mortality (p = 0.03) with univariate hazard ratio (HR) 1.25 [1.002-1.56, p=0.048]. Multivariate adjustment for age, BMI, hypertension, hyperlipidemia, chronic kidney disease yielded HR 1.28 [1.02-1.60, p=0.034]. Multivariate adjustment for aforementioned variables with addition of rEF, ObCAD and prior revascularization yielded HR 1.17 [0.93-1.48, p=0.19]. Conclusion: We conclude that poorly controlled diabetes with HbA1c 8 or greater carries independent mortality risk when controlled for traditional risk factors however loses significance after controlling for rEF, ObCAD and prior revascularization.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
