Association Between HbA1c and Coronary Artery Disease

The importance of the link between HbA1c and coronary artery disease: Heart disease said cause of one on every four deaths in the U.S.

According to the CDC, 610,000 people die from heart disease in the US annually. That’s one in every four deaths. Coronary heart disease is the most common, killing over 370,000 people yearly. Several medical conditions, including diabetes, and poor lifestyle choices can put people at a higher risk for heart disease.

Previous evidence has found a link between HbA1c and cardiovascular disease, although the studies have been mainly observational. According to recent study results published in Diabetes Care, HbA1c likely causes CAD, but the mechanisms are unclear.

In the study, Dr. Shiu Yeung and colleagues included 38 genetic variants strongly and independently related to HbA1c (n = 123,665) applied to the United Kingdom Biobank (n = 392,038). Using inverse variance weighting (IVW), they gathered the associations of HbA1c with cardiovascular disease, CAD, stroke, and stroke subtypes. Sensitivity analyses were performed using Mendelian randomization (MR)-Egger, a weighted median, and exclusion of potentially invalid single nucleotide polymorphisms (SNPs).

In the Biobank, there was no association between HbA1c and CVD using IVW (odds ratio (OR) 1.11 per %, 95% CI 0.83-1.48). However, there was an association found between HbA1c and an increased risk for CAD (OR 1.50 per % CI 1.08-2.11) with directionally consistent results from MR-Egger and weighted median. When potentially invalid SNPs were excluded, the positive association with CAD was more evident (OR 2.24 per %, 95% CI 1.55-3.25). Due to the lower number of cases, the association of HbA1c with stroke and its subtypes was less clear.

“Our study provides more evidence of a casual role of HbA1c in CAD. Interventions that target HbA1c reduction may be potential targets for reducing the global burden of CAD,” the researchers concluded.

Practice Pearls:

• One in every four deaths in the US are due to heart disease.
• According to recent study results published in Diabetes Care, HbA1c likely causes coronary artery disease, but the mechanisms are unclear.
• Interventions that target HbA1c reduction may be possible targets for reducing global incidences of coronary artery disease.

References:

Yeung, S., et al. “The Impact of Glycated Hemoglobin (HbA1c) on Cardiovascular Disease Risk: A Mendelian Randomization Study Using UK Biobank.” Diabetes Care. June 2018 dc180289; doi: 10.2337/dc18-0289

“Heart Disease.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 28 Nov. 2017, www.cdc.gov/heartdisease/facts.htm.

Melissa Bailey, Pharm.D. Candidate, USF College of Pharmacy