Abstract
BackgroundIntensive glycemic control is generally recommended for diabetic patients to reduce complications. However, the role of glycemic control in the mortality in diabetic patients with acute myocardial infarction (AMI) remained unclear.MethodsWe selected diabetic patients who measured HbA1c more than 3 times after AMI among 10,719 patients enrolled in the multicenter AMI registry. Patients (n = 1384) were categorized into five groups: according to mean HbA1c level: ≤ 6.5%, > 6.5 to ≤ 7.0%, > 7.0 to ≤ 7.5%, > 7.5 to ≤ 8.0% and > 8.0%. The primary endpoint was all-cause mortality.ResultsDuring a median follow-up of 6.2 years, the patients with a mean HbA1c of 6.5 to 7.0% had the lowest all-cause mortality. Compared to patients with mean HbA1c of 6.5 to 7.0%, the risk of all-cause mortality increased in subjects with mean HbA1c ≤ 6.5% (adjusted hazard ratio [HR] 2.00, 95% confidence interval [CI] 1.02–3.95) and in those with mean HbA1c > 8.0% (adjusted HR 3.35, 95% CI 1.78–6.29). In the subgroup analysis by age, the J-curve relationship between mean HbA1c and all-cause mortality was accentuated in elderly patients (age ≥ 65 years), while there was no difference in all-cause mortality across the HbA1c groups in younger patients (age < 65 years).ConclusionsThe less strict glycemic control in diabetic patients with AMI would be optimal for preventing mortality, especially in elderly patients.
Highlights
Intensive glycemic control is generally recommended for diabetic patients to reduce complications
One of the mechanisms of hypoglycemia-induced mortality would be the surge of adrenergic hormones, which may result in the increased risk of vasoconstriction, thrombogenesis, and ventricular arrhythmia [14]
Our study used mean Glycated hemoglobin (HbA1c) levels during longterm follow-up of acute myocardial infarction (AMI) patients. We demonstrated that both poor and stringent glycemic control was associated with increased mortality in AMI patients
Summary
Intensive glycemic control is generally recommended for diabetic patients to reduce complications. The role of glycemic control in the mortality in diabetic patients with acute myocardial infarction (AMI) remained unclear. Therapeutic strategies to manage blood pressure, lipid, and glucose levels have evolved in the past two decades to reduce the increased risk of macrovascular and microvascular complications in diabetic patients. The current guidelines recommend that intensive glucose control targeting HbA1c ≤ 6.5% to 7.0%, but HbA1c targets shall be individualized according to patients’ conditions [9–11]. Because intensive glucose control inevitably accompanies an increased risk of experiencing hypoglycemic events associated with increased mortality [12, 13]. The present study evaluated the effect of intensive glucose control on mortality in diabetic patients with AMI. We investigated whether the result of intensive glucose control differs according to patients’ age
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