The Association Between HbA1c Levels and the Risk of Myocardial Infarction and Stroke in People with Type 2 Diabetes: A Post Hoc Analysis of the REPRESENT Study.

INTRODUCTION

The aim of this work was to analyze the association between baseline glycated hemoglobin (HbA1c) levels and other factors on the risk of first myocardial infarction (MI) and on the risk of first stroke in people with type 2 diabetes (T2D) in Spain.

METHODS

This post hoc analysis of the REPRESENT study used the IQVIA electronic medical records database. Cumulative incidences were estimated using the Kaplan-Meier method, and Cox regression models were used to identify associated risk factors, including gender, age, HbA1c, or prior cardiovascular disease (other than MI/stroke).

RESULTS

Median follow-up was 7 years. In people without prior MI/stroke, the incidence (95% confidence interval [CI]) of first MI/stroke was 0.31 (0.28-0.34) and 0.18 (0.15-0.20) events per 100 patient-years, respectively. Baseline HbA1c levels < 6.5% were independently associated with lower risk of first MI (hazard ratio [HR] 0.76 [95% CI 0.61-0.94]) and of first stroke (HR 0.74 [95% CI 0.56-0.98]). Male sex, age ≥ 50 years, and previous cardiovascular disease were independently associated with a higher risk of MI/stroke.

CONCLUSIONS

This analysis found an association between baseline HbA1c levels < 6.5% and lower risk of a first MI or stroke in a T2D cohort in Spain, suggesting a role of stringent glycemic control in the prevention of cardiovascular complications.