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22-11-2021 | Diabetes | News | Article

CVD risk factors vary by HbA1c trajectory

Author:
Laura Cowen

medwireNews: Risk factors for cardiovascular disease (CVD) may vary by longitudinal glycated hemoglobin (HbA1c) trajectory in people with type 1 diabetes, US researchers report.

Rachel Miller and colleagues from the University of Pittsburgh in Pennsylvania say their study findings “suggest that in patients with poor glycemic control, traditional risk factors, such as cholesterol and smoking, may be overshadowed by HbA1c, thus playing a smaller role in discriminating long-term CVD risk.”

However, they add that “in the context of lower glycemic exposure, the importance of traditional CVD risk factors is more apparent.”

Therefore, “while it is important to treat dyslipidemia and high [blood pressure] in type 1 diabetes regardless of glycemic control, it may become increasingly beneficial to focus on these factors in those with relatively low HbA1c,” write the researchers in Diabetes Care.

Using 30 years of data from 536 participants of the Pittsburgh Epidemiology of Diabetes Complications study of childhood-onset type 1 diabetes who were free from CVD at baseline, Miller and team identified two HbA1c trajectories associated with differential CVD risks.

The low HbA1c trajectory group, comprising 76% of the cohort, had a mean baseline HbA1c of 8.4% (68 mmol/mol) that fell to 7.7% (61 mmol/mol) during follow-up. Of these people, 38% developed CVD by 30 years.

By comparison, the high HbA1c trajectory group, comprising 24% of the cohort, maintained a mean HbA1c of approximately 10% (86 mmol/mol) throughout follow-up, with 77% developing CVD.

After adjustment for baseline variables, the researchers found that the high HbA1c trajectory was associated with a 3.07-fold increased risk for CVD relative to the low trajectory.

Further adjustment for baseline and time-varying risk factors showed that longer diabetes duration, use of blood pressure-lowering medication, and higher white blood cell count were each significantly associated with increased CVD risk in both trajectory groups.

In addition, lower baseline HbA1c, higher baseline non-high-density lipoprotein cholesterol, lower most recent estimated glomerular filtration rate (eGFR), and being a current smoker were each associated with increased CVD risk in the low HbA1c trajectory group.

In the high HbA1c group, higher baseline albumin excretion rate (AER) was associated with increased CVD risk, which the investigators say points to “a notable difference in the associations between kidney damage (i.e., AER) and function (i.e., eGFR) and CVD risk by HbA1c trajectory.”

They add that this supports “prior evidence of distinct nonalbuminuric and albuminuric kidney disease phenotypes.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group

Diabetes Care 2021; doi:10.2337/dc21-1381

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