Effects of Intensive Glycemic Control on Ischemic Heart Disease
RESEARCH · August 01, 2014
TAKE-HOME MESSAGE
- To assess whether intensive lowering of glucose in patients with type 2 diabetes affects the risk for ischemic heart disease, investigators compared the outcome of intensive therapy with standard therapy over the course of about 5 years. Adults aged 40 to 79 years with type 2 diabetes, mean HbA1c of 8.3%, and risk factors for ischemic heart disease received either intensive therapy (target HbA1c <6.0%) or standard therapy (target HbA1c 7.0%–7.9%). Participants in the intensive group had fewer myocardial infarctions (HR, 0.80; 95% CI, 0.67–0.96). Results for coronary revascularization and unstable angina were similar.
- For adults with type 2 diabetes and cardiovascular risk factors, intensive lowering of glucose to a target HbA1c <6.0% was associated with lower risk for ischemic heart disease.
ABSTRACT
BACKGROUND
Hyperglycaemia could substantially increase the risk of ischaemic heart disease in patients with type 2 diabetes. We investigated whether intensive lowering of glucose concentrations affects risk.
METHODS
We assessed 10 251 adults aged 40—79 years with established type 2 diabetes, mean glycated haemoglobin A1c (HbA1c) concentration of 67 mmol/mol (8·3%), and risk factors for ischaemic heart disease enrolled in the ACCORD trial. Participants were assigned to intensive or standard therapy (target HbA1c less than 42 or 53—63 mmol/mol [less than 6·0% or 7·0—7·9%], respectively). We assessed fatal or non-fatal myocardial infarction, coronary revascularisation, unstable angina, and new angina during active treatment (mean 3·7 years) plus a further mean 1·2 years.
FINDINGS
Myocardial infarction was less frequent in the intensive than in the standard therapy group during active treatment (hazard ratio [HR] 0·80, 95% CI 0·67—0·96; p=0·015) and overall (0·84, 0·72—0·97; p=0·02). Findings were similar for combined myocardial infarction, coronary revascularisation, and unstable angina (active treatment HR 0·89, 95% CI 0·79—0·99, overall 0·87 0·79—0·96) and for coronary revascularisation alone (0·84, 0·75—0·94) and unstable angina alone (0·81, 0·67—0·97) during full follow-up. With lowest achieved HbA1C concentrations included as a time-dependent covariate, all hazards became non-significant.
INTERPRETATION
Raised glucose concentration is a modifiable risk factor for ischaemic heart disease in middle-aged people with type 2 diabetes and other cardiovascular risk factors.
The Lancet
Effects of Intensive Glycaemic Control on Ischaemic Heart Disease: Analysis of Data From the Randomised, Controlled ACCORD Trial
Effects of intensive glycaemic control on ischaemic heart disease: analysis of data from the randomised, controlled ACCORD trial
Prof Hertzel C Gerstein MD
The Lancet, Early Online Publication, 1 August 2014
doi:10.1016/S0140-6736(14)60611-5
Background
Hyperglycaemia could substantially increase the risk of ischaemic heart disease in patients with type 2 diabetes. We investigated whether intensive lowering of glucose concentrations affects risk.
Methods
We assessed 10 251 adults aged 40—79 years with established type 2 diabetes, mean glycated haemoglobin A1c (HbA1c) concentration of 67 mmol/mol (8·3%), and risk factors for ischaemic heart disease enrolled in the ACCORD trial. Participants were assigned to intensive or standard therapy (target HbA1c less than 42 or 53—63 mmol/mol [less than 6·0% or 7·0—7·9%], respectively). We assessed fatal or non-fatal myocardial infarction, coronary revascularisation, unstable angina, and new angina during active treatment (mean 3·7 years) plus a further mean 1·2 years. This trial is registered with ClinicalTrials.gov, number NCT00000620.
Findings
Myocardial infarction was less frequent in the intensive than in the standard therapy group during active treatment (hazard ratio [HR] 0·80, 95% CI 0·67—0·96; p=0·015) and overall (0·84, 0·72—0·97; p=0·02). Findings were similar for combined myocardial infarction, coronary revascularisation, and unstable angina (active treatment HR 0·89, 95% CI 0·79—0·99, overall 0·87 0·79—0·96) and for coronary revascularisation alone (0·84, 0·75—0·94) and unstable angina alone (0·81, 0·67—0·97) during full follow-up. With lowest achieved HbA1C concentrations included as a time-dependent covariate, all hazards became non-significant.
Interpretation
Raised glucose concentration is a modifiable risk factor for ischaemic heart disease in middle-aged people with type 2 diabetes and other cardiovascular risk factors.