Huang Dan, Huang Yong-Quan, Zhang Qun-Ying, Cui Yan, Mu Tian-Yi, Huang Yin
Emergency Department, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
Department of Ultrasound, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China.
Front Cardiovasc Med. 2021 Nov 24;8:777233. doi: 10.3389/fcvm.2021.777233. eCollection 2021.
To explore the association between visit-to-visit variability of glycated hemoglobin (HbA1c) and cardiovascular outcomes in the patients with type 2 diabetes mellitus (T2DM) of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study. We conducted a analysis on the ACCORD population including 9,544 participants with T2DM. Visit-to-visit variability of HbA1c was defined as the individual SD, coefficient of variation (CV), and variability independent of the mean (VIM) across HbA1c measurements. The clinical measurements included primary outcome [the first occurrence of non-fatal myocardial infarction (MI), non-fatal stroke or cardiovascular death], total mortality, cardiovascular death, non-fatal MI event, non-fatal stroke, total stroke, heart failure, macrovascular events, and major coronary events (CHD). Over a median follow-up of 4.85 years, 594 and 268 participants experienced all-cause mortality and cardiovascular mortality, respectively. After adjusting for baseline HbA1c levels and confounding factors, the adjusted hazard ratio (HR) comparing patients in the highest vs. the lowest quartile CV of HbA1c variability was 1.61 (95% CI 1.29-2.00) for the primary outcome. Similar trends for secondary outcome were also observed. There was no association between HbA1c fluctuation and non-fatal stroke. Noticeably, there was 66% greater risk for the all-cause mortality among patients in the highest vs. the lowest quartile (HR 1.66, 95% CI 1.27-2.17). Greater variability of HbA1c is associated with higher risk for cardiovascular complications and all-cause death in T2DM. Our study stresses the significance of well-controlled glycemic levels for improving cardiovascular outcomes. Further randomized clinical trials are required to confirm these findings.
为探讨糖化血红蛋白（HbA1c）的就诊间变异性与糖尿病控制心血管风险行动（ACCORD）研究中2型糖尿病（T2DM）患者心血管结局之间的关联。我们对ACCORD研究中9544名T2DM参与者进行了分析。HbA1c的就诊间变异性定义为HbA1c测量值的个体标准差、变异系数（CV）以及与均值无关的变异性（VIM）。临床测量指标包括主要结局[首次发生非致命性心肌梗死（MI）、非致命性卒中或心血管死亡]、全因死亡率、心血管死亡率、非致命性MI事件、非致命性卒中、总卒中、心力衰竭、大血管事件和主要冠状动脉事件（冠心病）。在中位随访4.85年期间，分别有594名和268名参与者经历了全因死亡和心血管死亡。在调整基线HbA1c水平和混杂因素后，主要结局方面，比较HbA1c变异性最高四分位数与最低四分位数患者的调整后风险比（HR）为1.61（95%CI 1.29 - 2.00）。次要结局也观察到类似趋势。HbA1c波动与非致命性卒中之间无关联。值得注意的是，最高四分位数与最低四分位数患者相比，全因死亡率风险高66%（HR 1.66，95%CI 1.27 - 2.17）。HbA1c变异性越大，T2DM患者发生心血管并发症和全因死亡的风险越高。我们的研究强调了严格控制血糖水平对改善心血管结局的重要性。需要进一步的随机临床试验来证实这些发现。
