Document Detail

Relationship between haemoglobin A1C values and recurrent cardiac events: A retrospective, longitudinal cohort study.
MedLine Citation:
PMID:  18598096     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: This study set out to analyse the impact of baseline glycosylated haemoglobin A1c (HbA1c) values on the incidence of recurrent cardiac events in patients prescribed optimal secondary prevention medications and receiving aggressive cardiac risk factor management. METHODS: This was a retrospective study conducted at Kaiser Permanente Colorado and included adults followed by a clinical pharmacy specialist-managed cardiac risk service (CPCRS) with an incident cardiac event and an HbA1c value measured within 1 year prior or 60 days after the incident cardiac event was identified. Cox proportional hazards models were constructed to assess the relationship between HbA1c levels and recurrent cardiac events (assessed as continuous and categorical measures) after adjustment for potential confounding variables. RESULTS: Of 5663 patients identified within an incident cardiac event between January 1999 and March 2005, 1270 (22.4%) patients had a baseline HbA1c value recorded. Of these 1270 patients, 215 (16.9%) had a recurrent cardiac event. Compared with the 'no recurrent event' cohort, the 'recurrent event' cohort were younger, less likely to have undergone an initial coronary artery bypass graft, and more likely to have undergone percutaneous coronary intervention with or without stent. The recurrent event cohort was also less likely to have purchased an HMG-CoA reductase inhibitor ('statin') [p = 0.043] at the time of the incident cardiac event. There was no significant difference in mean baseline HbA1c value between the cohorts. There were also no significant differences between the cohorts when categorized by baseline HbA1c <7% as referent compared with > or =7% to <8%, > or =8% to <9%, > or =9 to <10%, and > or =10%. Moreover, there was no significant difference between cohorts when HbA1c values <7% were compared with values >7% in the unadjusted analysis. Results remained non-significant after adjustment for sex, incident cardiac event type, baseline age, ss-blocker use, statin use and hyperlipidaemia. CONCLUSION: The results of this study suggest that an abnormal HbA1c is not predictive of recurrent cardiac events among patients with cardiovascular disease when other cardiovascular risk factors are being aggressively treated and appropriate secondary prevention medications are being taken. However, larger studies are warranted to validate these findings.
Amy B Kauffman; Thomas Delate; Kari L Olson; Alicia A Cymbala; Kara A Hutka; Sheila L Kasten; Jon R Rasmussen
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical drug investigation     Volume:  28     ISSN:  1173-2563     ISO Abbreviation:  Clin Drug Investig     Publication Date:  2008  
Date Detail:
Created Date:  2008-07-07     Completed Date:  2008-10-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9504817     Medline TA:  Clin Drug Investig     Country:  New Zealand    
Other Details:
Languages:  eng     Pagination:  501-7     Citation Subset:  IM    
Kaiser Permanente Colorado, Aurora, Colorado, USA.
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MeSH Terms
Adrenergic beta-Antagonists / therapeutic use
Angiotensin-Converting Enzyme Inhibitors / therapeutic use
Aspirin / therapeutic use
Cardiovascular Diseases / diagnosis*,  prevention & control*
Hemoglobin A, Glycosylated / analysis*
Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
Hypoglycemic Agents / therapeutic use
Longitudinal Studies
Platelet Aggregation Inhibitors
Predictive Value of Tests
Retrospective Studies
Risk Assessment
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Hemoglobin A, Glycosylated; 0/Hydroxymethylglutaryl-CoA Reductase Inhibitors; 0/Hypoglycemic Agents; 0/Platelet Aggregation Inhibitors; 50-78-2/Aspirin

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