Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Mar;8(2):236-42.
doi: 10.1161/CIRCHEARTFAILURE.113.000920. Epub 2015 Jan 5.

Both high and low HbA1c predict incident heart failure in type 2 diabetes mellitus

Helen M Parry  1 , Harshal Deshmukh  2 , Daniel Levin  2 , Natalie Van Zuydam  2 , Douglas H J Elder  2 , Andrew D Morris  2 , Allan D Struthers  2 , Colin N A Palmer  2 , Alex S F Doney  2 , Chim C Lang  2
Affiliations

Both high and low HbA1c predict incident heart failure in type 2 diabetes mellitus

Helen M Parry et al. Circ Heart Fail. 2015 Mar.

Abstract

Background: Type 2 diabetes mellitus is an independent risk factor for heart failure development, but the relationship between incident heart failure and antecedent glycemia has not been evaluated.

Methods and results: The Genetics of Diabetes Audit and Research in Tayside Study study holds data for 8683 individuals with type 2 diabetes mellitus. Dispensed prescribing, hospital admission data, and echocardiography reports were linked to extract incident heart failure cases from December 1998 to August 2011. All available HbA1c measures until heart failure development or end of study were used to model HbA1c time-dependently. Individuals were observed from study enrolment until heart failure development or end of study. Proportional hazard regression calculated heart failure development risk associated with specific HbA1c ranges accounting for comorbidities associated with heart failure, including blood pressure, body mass index, and coronary artery disease. Seven hundred and one individuals with type 2 diabetes mellitus (8%) developed heart failure during follow up (mean 5.5 years, ±2.8 years). Time-updated analysis with longitudinal HbA1c showed that both HbA1c <6% (hazard ratio =1.60; 95% confidence interval, 1.38-1.86; P value <0.0001) and HbA1c >10% (hazard ratio =1.80; 95% confidence interval, 1.60-2.16; P value <0.0001) were independently associated with the risk of heart failure.

Conclusions: Both high and low HbA1c predicted heart failure development in our cohort, forming a U-shaped relationship.

Keywords: diabetes mellitus; echocardiography; glucose.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow chart showing method of case selection
Figure 2
Figure 2
Relationship between time-updated HbA1c and the development of heart failure in type 2 diabetes, including age, duration of diabetes, gender, history of coronary artery disease, body mass index, creatinine, systolic and diastolic blood pressure as covariate.
See this image and copyright information in PMC

References

    1. Gottdiener JS, Arnold AM, Aurigemma GP, Polak JF, Tracy RP, Kitzman DW, Gardin JM, Rutledge JE, Boineau RC. Predictors of congestive heart failure in the elderly: the Cardiovascular Health Study. J Am Coll Cardiol. 2000;35:1628–37. - PubMed
    1. Peterson L, McKenzie C, Schaffer J. Diabetic Cardiovascular Disease: Getting to the Heart of the Matter. J of Cardiovasc Trans Res. 2012;5:436–45. - PMC - PubMed
    1. Boudina S, Abel ED. Diabetic cardiomyopathy revisited. Circulation. 2007;115:3213–23. - PubMed
    1. Cohn JN, Johnson G, Ziesche S, Cobb F, Francis G, Tristani F, Smith R, Dunkman WB, Loeb H, Wong M, Bhat G, Goldman S, Fletcher RD, Doherty J, Hughes CV, Carson P, Cintron G, Shabetai R, Haakenson C. A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congestive heart failure. N Engl J Med. 1991;325:303–10. - PubMed
    1. Wold LE, Ceylan-Isik AF, Fang CX, Yang X, Li SY, Sreejayan N, Privratsky JR, Ren J. Metallothionein alleviates cardiac dysfunction in streptozotocin-induced diabetes: role of Ca2+ cycling proteins, NADPH oxidase, poly(ADP-Ribose) polymerase and myosin heavy chain isozyme. Free Radic Biol Med. 2006;40:1419–29. - PubMed

Publication types

Substances