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Article: Relation between HbA1c and incident cardiovascular disease over a period of 6 years in the Hong Kong population

TitleRelation between HbA1c and incident cardiovascular disease over a period of 6 years in the Hong Kong population
Authors
KeywordsManagement
Haemoglobin A1c
Diabetes mellitus
Cardiovascular diseases
Primary care
Issue Date2018
Citation
Diabetes and Metabolism, 2018, v. 44, n. 5, p. 415-423 How to Cite?
AbstractAim: The current trend on diabetes management advocates replacing the paradigm from a uniform to an individualized patient-centered haemoglobin A1c (HbA1c) target, but there is no consensus on the optimal HbA1c level. The study aimed at examining the association between HbA1c and the risk of cardiovascular diseases (CVD) for diabetic patients with different characteristics, in order to identify patient-centered treatment targets. Methods: A retrospective cohort study was conducted on 115,782 Chinese adult primary care patients with type 2 diabetes mellitus (DM) but no known CVD history, who were prescribed antidiabetic medications in 2010–2011. The cumulative mean HbA1c over a median follow-up period of 5.8 years was used to evaluate the relationship between HbA1c and CVD incidence using Cox analysis. Subgroup analyses were conducted by stratifying different baseline characteristics including gender, age, smoking status, diabetes duration, body mass index, Charlson's comorbidity index and DM treatment modalities. Results: For patients with a DM duration of < 2years, an exponential relationship between HbA1c and risk of CVD was identified, suggesting that there was no threshold HbA1c level for CVD risk. For other diabetic patients, an HbA1c level of 6.8–7.2% was associated with a minimum risk for CVD and a J-shaped curvilinear association between HbA1c. The risk of CVD increased in patients with HbA1c < 6.5% or ≥ 7.5%. Conclusion: Among Chinese primary care patients at the early (< 2years) disease stage, lower HbA1c targets (< 6.5%) may be warranted to prevent CVD events whilst for all others, excessively lower HbA1c levels may not necessarily better and can potentially be harmful.
Persistent Identifierhttp://hdl.handle.net/10722/267599
ISSN
2017 Impact Factor: 3.744
2015 SCImago Journal Rankings: 1.252
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorWan, YF-
dc.contributor.authorYu, EYT-
dc.contributor.authorFung, CSC-
dc.contributor.authorChin, WY-
dc.contributor.authorFong, DYT-
dc.contributor.authorChan, KC-
dc.contributor.authorLam, CLK-
dc.date.accessioned2019-02-22T04:08:28Z-
dc.date.available2019-02-22T04:08:28Z-
dc.date.issued2018-
dc.identifier.citationDiabetes and Metabolism, 2018, v. 44, n. 5, p. 415-423-
dc.identifier.issn1262-3636-
dc.identifier.urihttp://hdl.handle.net/10722/267599-
dc.description.abstractAim: The current trend on diabetes management advocates replacing the paradigm from a uniform to an individualized patient-centered haemoglobin A1c (HbA1c) target, but there is no consensus on the optimal HbA1c level. The study aimed at examining the association between HbA1c and the risk of cardiovascular diseases (CVD) for diabetic patients with different characteristics, in order to identify patient-centered treatment targets. Methods: A retrospective cohort study was conducted on 115,782 Chinese adult primary care patients with type 2 diabetes mellitus (DM) but no known CVD history, who were prescribed antidiabetic medications in 2010–2011. The cumulative mean HbA1c over a median follow-up period of 5.8 years was used to evaluate the relationship between HbA1c and CVD incidence using Cox analysis. Subgroup analyses were conducted by stratifying different baseline characteristics including gender, age, smoking status, diabetes duration, body mass index, Charlson's comorbidity index and DM treatment modalities. Results: For patients with a DM duration of < 2years, an exponential relationship between HbA1c and risk of CVD was identified, suggesting that there was no threshold HbA1c level for CVD risk. For other diabetic patients, an HbA1c level of 6.8–7.2% was associated with a minimum risk for CVD and a J-shaped curvilinear association between HbA1c. The risk of CVD increased in patients with HbA1c < 6.5% or ≥ 7.5%. Conclusion: Among Chinese primary care patients at the early (< 2years) disease stage, lower HbA1c targets (< 6.5%) may be warranted to prevent CVD events whilst for all others, excessively lower HbA1c levels may not necessarily better and can potentially be harmful.-
dc.languageeng-
dc.relation.ispartofDiabetes and Metabolism-
dc.subjectManagement-
dc.subjectHaemoglobin A1c-
dc.subjectDiabetes mellitus-
dc.subjectCardiovascular diseases-
dc.subjectPrimary care-
dc.titleRelation between HbA1c and incident cardiovascular disease over a period of 6 years in the Hong Kong population-
dc.typeArticle-
dc.description.natureLink_to_subscribed_fulltext-
dc.identifier.doi10.1016/j.diabet.2018.01.012-
dc.identifier.pmid29449147-
dc.identifier.scopuseid_2-s2.0-85044646613-
dc.identifier.volume44-
dc.identifier.issue5-
dc.identifier.spage415-
dc.identifier.epage423-
dc.identifier.eissn1878-1780-
dc.identifier.isiWOS:000453648300006-

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