The Relationship Between Time-Varying Achieved HbA1c and Risk of Coronary Events Depends on Haptoglobin Phenotype Among White and Black ACCORD Participants.

IF 14.8 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Diabetes Care Pub Date : 2023-11-01 DOI:10.2337/dc23-0760
Leah E Cahill, Rachel A Warren, Allie S Carew, Andrew P Levy, Henry N Ginsberg, John Sapp, Orit Lache, Eric B Rimm
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引用次数: 0

Abstract

Objective: Intensive glycemic therapy reduced coronary artery disease (CAD) events among White participants in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study with the haptoglobin (Hp)2-2 phenotype, while participants without the Hp2-2 phenotype had no CAD benefit. The association between achieved glycated hemoglobin (HbA1c) and CAD for each Hp phenotype remains unknown.

Research design and methods: Achieved HbA1c was similar in each phenotype throughout the study. Prospectively collected HbA1c data (categorized as <6.0%, 6.0-6.5%, 6.6-6.9%, or ≥8.0% compared with 7.0-7.9%) from the ACCORD study, updated every 4 months over a median of 4.7 years, were analyzed in relation to CAD in the Hp2-2 (n = 3,322) and non-Hp2-2 (n = 5,949) phenotypes separately overall, and within White (63%, 37% Hp2-2) and Black (19%, 26% Hp2-2) participants using Cox proportional hazards regression with time-varying covariables.

Results: Compared with HbA1c of 7.0-7.9%, having HbA1c ≥8.0% was associated with CAD risk among White (adjusted HR [aHR] 1.43, 95% CI 1.03-1.98) and Black (2.86, 1.09-7.51) participants with the Hp2-2 phenotype, but not when all Hp2-2 participants were combined overall (1.30, 0.99-1.70), and not among participants without the Hp2-2 phenotype. HbA1c <7.0% was not associated with a lower risk of CAD for any Hp phenotype.

Conclusions: Achieving HbA1c >8.0% compared with 7.0-7.9% was consistently associated with incident CAD risk among White and Black ACCORD participants with the Hp2-2 phenotype, while no association was observed among participants without the Hp2-2 phenotype. We found no evidence that HbA1c concentration <7.0% prevents CAD in either Hp phenotype group.

白人和黑人ACCORD参与者的时变糖化血红蛋白与冠状动脉事件风险之间的关系取决于触珠蛋白表型。
目的:强化血糖治疗减少了糖尿病心血管风险控制行动(ACCORD)研究中具有触珠蛋白(Hp)2-2表型的白人参与者的冠状动脉疾病(CAD)事件,而没有Hp 2-2表型的参与者没有CAD益处。每种Hp表型的糖化血红蛋白(HbA1c)与CAD之间的关系尚不清楚。研究设计和方法:在整个研究过程中,每个表型的糖化血红蛋白都是相似的。前瞻性收集HbA1c数据(分类为结果:与7.0-7.9%的HbA1c相比,在具有Hp2-2表型的白人(调整后的HR[aHR]1.43,95%CI 1.03-1.98)和黑人(2.86,1.09-7.51)参与者中,HbA1c≥8.0%与CAD风险相关,但当所有Hp2-2参与者总体合并时(1.30,0.99-1.70)则不相关,在没有Hp2-2表现型的参与者中也不相关。HbA1c结论:在具有Hp2-2表型的白人和黑人ACCORD参与者中,HbA1c>8.0%与7.0-7.9%始终与CAD风险相关,而在没有Hp2-2表现型的参与者中没有观察到相关性。我们没有发现HbA1c浓度
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来源期刊
Diabetes Care
Diabetes Care 医学-内分泌学与代谢
CiteScore
27.80
自引率
4.90%
发文量
449
审稿时长
1 months
期刊介绍: The journal's overarching mission can be captured by the simple word "Care," reflecting its commitment to enhancing patient well-being. Diabetes Care aims to support better patient care by addressing the comprehensive needs of healthcare professionals dedicated to managing diabetes. Diabetes Care serves as a valuable resource for healthcare practitioners, aiming to advance knowledge, foster research, and improve diabetes management. The journal publishes original research across various categories, including Clinical Care, Education, Nutrition, Psychosocial Research, Epidemiology, Health Services Research, Emerging Treatments and Technologies, Pathophysiology, Complications, and Cardiovascular and Metabolic Risk. Additionally, Diabetes Care features ADA statements, consensus reports, review articles, letters to the editor, and health/medical news, appealing to a diverse audience of physicians, researchers, psychologists, educators, and other healthcare professionals.
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