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

Helen M. Parry; Harshal Desmukh; Daniel Levin; Natalie Van Zuydam; Douglas H. J. Elder; Andrew D. Morris; Allan D. Struthers; Colin N. A. Palmer; Alex S. F.  Doney; Chim C. Lang

doi:10.1161/CIRCHEARTFAILURE.113.000920

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

Helen M. Parry (Lead / Corresponding author), Harshal Desmukh, Daniel Levin, Natalie Van Zuydam, Douglas H. J. Elder, Andrew D. Morris, Allan D. Struthers, Colin N. A. Palmer, Alex S. F. Doney, Chim C. Lang

Research output: Contribution to journal › Article › peer-review

47 Citations (Scopus)

Abstract

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

METHODS AND RESULTS: -The Go-DARTS study holds data for 8683 individuals with type 2 diabetes. 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 (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% (HR = 1.60, 95% CI 1.38-1.86 P-value= <0.0001) as well as HbA1c> 10% (HR = 1.80, 95% CI 1.60-2.16 P-value= <0.0001) were independently associated with the risk of HF.

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

Original language	English
Pages (from-to)	236-242
Number of pages	7
Journal	Circulation: Heart Failure
Volume	8
Issue number	2
Early online date	5 Jan 2015
DOIs	https://doi.org/10.1161/CIRCHEARTFAILURE.113.000920
Publication status	Published - Mar 2015

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10.1161/CIRCHEARTFAILURE.113.000920Licence: Other

The Scottish eHealth Informatics Research Centre (E-HIRCs) (Joint with Universities of Aberdeen, Glasgow, Edinburgh, Strathclyde, St Andrews & Leicester and ISD)
Colhoun, H. (Investigator), Donnan, P. (Investigator), Guthrie, B. (Investigator), Jefferson, E. (Investigator), MacDonald, T. (Investigator), McCowan, C. (Investigator), Morris, A. (Investigator), Pearson, E. (Investigator), Sullivan, F. (Investigator) & Swedlow, J. (Investigator)
Medical Research Council
1/03/13 → 31/12/18
Project: Research

Lang, Chim
- Cardiovascular Research - Clinical Professor (Teaching and Research)
Person: Academic

Health Informatics Centre
Health and Clinical Services
Facility/equipment: Facility

Cite this

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title = "Both high and low HbA1c predict incident heart failure in type 2 diabetes mellitus",

abstract = "BACKGROUND: -Type 2 diabetes is an independent risk factor for heart failure development, but the relationship between incident heart failure and antecedent glycaemia has not been evaluated.METHODS AND RESULTS: -The Go-DARTS study holds data for 8683 individuals with type 2 diabetes. 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 (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% (HR = 1.60, 95% CI 1.38-1.86 P-value= <0.0001) as well as HbA1c> 10% (HR = 1.80, 95% CI 1.60-2.16 P-value= <0.0001) were independently associated with the risk of HF.CONCLUSIONS: -Both high and low HbA1c predicted heart failure development in our cohort, forming a U-shaped relationship.",

author = "Parry, {Helen M.} and Harshal Desmukh and Daniel Levin and {Van Zuydam}, Natalie and Elder, {Douglas H. J.} and Morris, {Andrew D.} and Struthers, {Allan D.} and Palmer, {Colin N. A.} and Doney, {Alex S. F.} and Lang, {Chim C.}",

year = "2015",

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doi = "10.1161/CIRCHEARTFAILURE.113.000920",

language = "English",

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pages = "236--242",

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AU - Parry, Helen M.

AU - Desmukh, Harshal

AU - Levin, Daniel

AU - Van Zuydam, Natalie

AU - Elder, Douglas H. J.

AU - Morris, Andrew D.

AU - Struthers, Allan D.

AU - Palmer, Colin N. A.

AU - Doney, Alex S. F.

AU - Lang, Chim C.

PY - 2015/3

Y1 - 2015/3

N2 - BACKGROUND: -Type 2 diabetes is an independent risk factor for heart failure development, but the relationship between incident heart failure and antecedent glycaemia has not been evaluated.METHODS AND RESULTS: -The Go-DARTS study holds data for 8683 individuals with type 2 diabetes. 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 (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% (HR = 1.60, 95% CI 1.38-1.86 P-value= <0.0001) as well as HbA1c> 10% (HR = 1.80, 95% CI 1.60-2.16 P-value= <0.0001) were independently associated with the risk of HF.CONCLUSIONS: -Both high and low HbA1c predicted heart failure development in our cohort, forming a U-shaped relationship.

AB - BACKGROUND: -Type 2 diabetes is an independent risk factor for heart failure development, but the relationship between incident heart failure and antecedent glycaemia has not been evaluated.METHODS AND RESULTS: -The Go-DARTS study holds data for 8683 individuals with type 2 diabetes. 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 (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% (HR = 1.60, 95% CI 1.38-1.86 P-value= <0.0001) as well as HbA1c> 10% (HR = 1.80, 95% CI 1.60-2.16 P-value= <0.0001) were independently associated with the risk of HF.CONCLUSIONS: -Both high and low HbA1c predicted heart failure development in our cohort, forming a U-shaped relationship.

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DO - 10.1161/CIRCHEARTFAILURE.113.000920

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

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The Scottish eHealth Informatics Research Centre (E-HIRCs) (Joint with Universities of Aberdeen, Glasgow, Edinburgh, Strathclyde, St Andrews & Leicester and ISD)

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Lang, Chim

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Health Informatics Centre

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