Abstract
ObjectivesGlycated hemoglobin (HbA1c) is associated with an increased risk of cardiovascular disease. The aim of this study was to examine the relationship between HbA1c levels and the complexity of coronary artery lesions among the older patients with diabetes mellitus (DM).MethodsThis retrospective study enrolled a total of 3805 consecutive type 2 DM patients aged 60 years and older who underwent their first elective coronary angiography and had their HbA1c levels measured at the Chinese PLA General Hospital between December 2005 and December 2012.The complexity of the coronary artery lesions was evaluated using the Syntax score, and the subjects were divided into three groups according to their HbA1c levels. Logistic regression and Pearson correlation were used to analyze the association between the measured HbA1c levels and Syntax score.ResultsThe mean age was 72.3±10.6 years. The higher HbA1c levels were significantly associated with higher Syntax score (p<0.001). The unadjusted correlation coefficient of HbA1c levels and the Syntax score was 0. 371 (p<0.001). In addition, the higher HbA1c categories were able to independently predict patients with intermediate or high Syntax score (Syntax score ≥23) after adjustment for age, sex, hypertension, smoking, dyslipidemia and creatinine levels in the logistic regression analysis.ConclusionHbA1c is significantly associated with the complexity of coronary lesions among older patients with DM. A higher HbA1c value is an independent predictor of the prevalence of complex coronary lesions. Further prospective multi-centre studies are needed to confirm this finding.
Highlights
Diabetes mellitus (DM) is an important risk factor for coronary heart disease [1], and it is associated with a high prevalence of coronary artery disease (CAD) and an unfavorable prognosis [2]
Syntax score was significantly different among the HbA1c groups, p,0.001(Fig 1)
The higher HbA1c category was significantly associated with age, a higher proportion of male sex and hypertention, higher low density lipoprotein (LDL) cholesterol and triglyceride, and lower high density lipoprotein (HDL) cholesterol
Summary
Diabetes mellitus (DM) is an important risk factor for coronary heart disease [1], and it is associated with a high prevalence of coronary artery disease (CAD) and an unfavorable prognosis [2]. Glycated hemoglobin (HbA1c) reflects the average blood glucose concentrations over the preceding 2 to 3 months [3]. HbA1c levels may be of prognostic value with regard to future cardiovascular disease [6]. Several previous studies have demonstrated positive correlations of HbA1c with mortality and even subclinical cardiovascular disease in subjects without a history of diabetes [7,8,9,10]. Selvin et al demonstrated that the HbA1c was a strong predictor of future DM, cardiovascular disease, and all cause of mortality [11]. DM is a major health problem for the aging population. Ageing is another factor that contributes to variance in the HbA1c and diabetes risk [12]. The fear of iatrogenic hypoglycemia makes achievement of optimal glycemic control and HbA1c levels complex and generally only partially successful
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