Huang Jia-Yi, Cai An-Ping, Tsang Christopher Tze Wei, Wu Mei-Zhen, Gu Wen-Li, Guo Ran, Zhang Jing-Nan, Zhu Ching-Yan, Hung Yik-Ming, Lip Gregory Y H, Yiu Kai-Hang
Division of Cardiology, Department of Medicine, The University of Hong Kong-Shen Zhen Hospital, Shen Zhen, 518000, China.
Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Room 1929B/K1931, Block K, Hong Kong, 999077, China.
Eur J Prev Cardiol. 2024 Dec 23;31(18):2073-2083. doi: 10.1093/eurjpc/zwae249.
The association of haemoglobin A1c (HbA1c) variability with the risk of adverse outcomes in patients with atrial fibrillation (AF) prescribed anticoagulants remains unclear. This study aimed to evaluate the association of HbA1c variability with the risk of ischaemic stroke (IS)/systemic embolism (SE) and all-cause mortality among patients with non-valvular AF prescribed anticoagulants.
Patients newly diagnosed with AF from 2013 to 2018 were included. Variability in HbA1c, indexed by the coefficient of variation (CV), was determined for those with at least three HbA1c measurements available from the time of study enrolment to the end of follow-up. To evaluate whether prevalent diabetes would modify the relationship between HbA1c variability and outcomes, participants were divided into diabetes and non-diabetes groups. The study included 8790 patients (mean age 72.7% and 48.5% female). Over a median follow-up of 5.5 years (interquartile range 5.2, 5.8), the incident rate was 3.74 per 100 person-years for IS/SE and 4.89 for all-cause mortality in the diabetes group. The corresponding incident rates in the non-diabetes group were 2.41 and 2.42 per 100 person-years. In the diabetes group, after adjusting for covariates including mean HbA1c, greater HbA1c variability was significantly associated with increased risk of IS/SE [hazard ratio (HR) = 1.65, 95% confidence interval (CI): 1.27-2.13) and all-cause mortality (HR = 1.24, 95% CI: 1.05-1.47) compared with the lowest CV tertile. A similar pattern was evident in the non-diabetes group (IS/SE: HR = 1.58, 95% CI: 1.23-2.02; all-cause mortality: HR = 1.35, 95% CI: 1.10-1.64).
Greater HbA1c variability was independently associated with increased risk of IS/SE and all-cause mortality among patients with AF, regardless of diabetic status.
血红蛋白A1c（HbA1c）变异性与接受抗凝治疗的心房颤动（AF）患者不良结局风险之间的关联尚不清楚。本研究旨在评估HbA1c变异性与接受抗凝治疗的非瓣膜性AF患者发生缺血性卒中（IS）/全身性栓塞（SE）风险及全因死亡率之间的关联。
纳入2013年至2018年新诊断为AF的患者。对于从研究入组至随访结束时有至少三次HbA1c测量值的患者，以变异系数（CV）为指标确定HbA1c的变异性。为评估糖尿病是否会改变HbA1c变异性与结局之间的关系，将参与者分为糖尿病组和非糖尿病组。该研究纳入了8790例患者（平均年龄，女性占72.7%和48.5%）。在中位随访5.5年（四分位间距5.2，5.8）期间，糖尿病组中IS/SE的发生率为每100人年3.74例，全因死亡率为每100人年4.89例。非糖尿病组中相应的发生率分别为每100人年2.41例和2.42例。在糖尿病组中，在调整包括平均HbA1c在内的协变量后，与最低CV三分位数相比，更大的HbA1c变异性与IS/SE风险增加显著相关[风险比（HR）=1.65，95%置信区间（CI）：1.27 - 2.13]及全因死亡率（HR = 1.24，95% CI：1.05 - 1.47）。非糖尿病组中也有类似模式（IS/SE：HR = 1.58，95% CI：1.23 - 2.02；全因死亡率：HR = 1.35，95% CI：1.10 - 1.64）。
无论糖尿病状态如何，更大的HbA1c变异性与AF患者发生IS/SE风险及全因死亡率增加独立相关。
