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Glycemic Control Reduces Risk of Strokes and Heart Attacks Dramatically

A retrospective analysis of 69,418 patients with diabetes showed that elevated A1C levels were statistically significantly associated with higher risk of macrovascular events. The new findings presented at the European Association for the Study of Diabetes’ 43rd Annual Meeting, add to the growing debate in the diabetes community about glycemic control and the cardiovascular risks associated with diabetes.

The Hemoglobin A1C test measures average blood glucose levels over a two- to three-month period. Compared to the group of patients with A1C<6% the hazard risk for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) surgery or stroke was higher in patients with A1C between 7 and 9% by 8% (p<0.01) and 15% (p<0.001) in the A1C?9% group.

Patients in the data base were 54% male, with a mean age of 57 years, an index A1C 7.6% and a mean followup from A1C index of 27 months. The patients were stratified into 4 groups based on index A1C: <6 %, 6 -7 %, 7 -9 %, and ?9 %. Survival analysis was conducted to examine the first occurrence of acute myocardial infarction, CABG surgery or stroke after index A1C control with patients being censored at the end of their health plan enrollment.

Heart disease and stroke account for approximately 65% of deaths in people with diabetes. This finding
demonstrating a high incidence of macrovascular events in diabetic patients with A1C >7% is important
because appropriate glycemic control may contribute to reducing the risks of macrovascular diseases in this patients population.

“Elevated A1C level is a significant risk factor for myocardial infarction, coronary artery bypass graft surgery and stroke in patients with diabetes. Early intervention with intensive diabetes treatment may reduce these macrovascular risks,” stated Pr. J. M. Foody, Internal Medicine/Section of Cardiology, Yale University School of Medicine, New Haven, United States.

Being the most potent mean of lowering blood sugar levels, insulin should be the appropriate treatment to improve cardiovascular outcomes in at-risk patients elevated A1C directly for T1 patients and in spite of appropriate diet and oral antidiabetic treatment for T2 patients.

Nathan et al. “Management of hyperglycemia in type 2 diabete: a consensus algorithm for the initiation
and adjustment of therapy” Diabetologia 2006; 49:1711-1721