HbAc impact on cardiovascular health -
However, b-HbA1c and f-HbA1c were higher in the insulin-treated group than in the noninsulin-treated group Table 3. Interactions between f-HbA1c and insulin therapy on 3p-MACE outcomes were assessed.
The unadjusted HR was 1. This study found that patients with T2DM with poor glycemic control had a significantly increased risk of severe coronary stenosis compared to those with good glycemic control. b-HbA1c was a risk factor but not an independent risk factor for the 3p-MACE in T2DM with CHD patients.
In contrast, f-HbA1c was an independent risk factor for 3p-MACE in these patients. T2DM promotes the development and progression of atherosclerosis, including not only traditional risk factors such as genetic factors, hyperglycemia, obesity, lipid metabolism disorders, sex hormone abnormalities, advanced age, and smoking but also nontraditional risk factors such as hyperinsulinemia, insulin resistance, diabetic hypercoagulable state, diabetic endothelial dysfunction, advanced glycosylation end products, oxidative stress, diabetic inflammation, microproteinuria, and hyperhomocysteinemia [ 13 ].
HbA1c is not only used to diagnose T2DM but can also be used to identify people at high cardiovascular risk. The higher the HbA1c level, the greater the risk of cardiovascular events in patients with T2DM [ 14 ]. Hyperglycaemia damages the cardiovascular system and induces atherosclerosis through several mechanisms, such as endothelial cell damage, oxidative stress, and imbalances in the coagulation and fibrinolytic systems, leading to diffuse coronary artery disease.
Although previous studies have shown a positive correlation between high levels of HbA1c and the severity of coronary artery disease, these have been limited to specific types of coronary artery disease [ 14 , 15 , 16 ]. The risk of b-HbA1c levels to coronary artery disease in a population of patients not differentiated by CHD type is currently unknown.
This study assessed the severity of coronary lesions based on CAG using the Gensini score and found a positive correlation between b-HbA1c levels and the severity of coronary lesions, in line with previous studies [ 17 , 18 ].
The Gensini score is a scientific evaluation standard of coronary artery lesions, taking into account the number, location, and severity of stenosis of coronary artery lesions [ 10 ].
And it is a useful tool for assessing the severity of CHD [ 19 ]. Many studies have examined the prognostic impact of baseline blood glucose levels on patients with CHD.
Still, most have been limited to patients with AMI or PCI, suggesting a positive association between b-HbA1c and poor prognosis [ 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. b-HbA1c significantly predicted adverse cardiovascular events at prognosis [ 27 ]. A Chinese population-based study also showed no significant difference in prognosis between groups with different b-HbA1c levels in patients with T2DM combined with CHD who underwent PCI [ 28 ].
This study found that b-HbA1c was a risk factor for 3p-MACE in T2DM with CHD patients but was not an independent risk factor and was influenced by other factors such as age, duration of diabetes, hypertension, etc. Therefore, in patients with both T2DM and CHD, b-HbA1c alone cannot be used as an indicator to predict the long-term risk of 3p-MACE.
The prognosis of patients with CHD is closely related to glycemic control at follow-up. The poorer the glycemic control at follow-up and the need for insulin control, the higher the risk of developing 3p-MACE. It showed a higher incidence of 3p-MACE in the insulin-treated group. Meanwhile, there was relatively poorer glycemic control in the insulin-treated group.
The DIGAMI-2 study in found that intensive glycemic control reduced mortality in heart attack patients [ 29 ]. The subsequent DIGAMI-1 in found that glycemic control by insulin therapy significantly reduced 1-year mortality in patients with acute infarction compared to the conventional treatment group.
This finding contradicts the results of this study [ 30 ]. We found the risk of 3p-MACE in patients with both T2DM and CHD increased with the higher f-HbA1c in the insulin treatment group. In comparison, it was not significant in the patients without insulin treatment.
And patients with f-HbA1c values above the national 8. The novelty of our study was that in addition to measuring the pre-CAG HbA1c as the level of the b-HbA1c value, the post-CAG HbA1c was also tested as the f-HbA1c.
Thus, it reflects not only the relationship between glycemic control before CAG and CHD severity but also the impact of different stages of glycemic control on the prognosis of patients with both T2DM and CHD. Second, further threshold effect analyses were performed to determine which range of HbA1c was more likely to lead to severe CHD and adverse cardiovascular events and to guide clinicians in developing an individualized glycaemic management strategy for patients when b-HbA1c and f-HbA1c levels were found to correlate with the severity of coronary stenosis and the risk of 3p-MACE.
However, there were some limitations in this study. As this was a retrospective cohort study, much of the data were obtained from hospital databases or by reviewing patients' medical records, and some of the data were missing.
For example, there were no specific descriptions of smoking and drinking history, data on whether patients had been treated with statins before hospitalization were incomplete, and many patients did not have a urine albumin creatinine ratio, so these indicators were not included in the data analysis.
Smoking [ 32 ], alcohol history [ 33 ], statin treatment [ 34 ], and urine microalbumin [ 35 ] have been shown to be strongly associated with cardiovascular disease, so the absence of such data at baseline may have had some impact on the results.
As study excluded patients on tumor and renal failure dialysis at the time of inclusion, which significantly reduced the number of deaths of patients due to these causes, and only three deaths from other causes were observed at follow-up.
So the cox regression model did not include death from other causes as a competing risk, which may have affected the study results. Furthermore, as the assessment of coronary angiograms could only be based on what was available in the medical records, it was not possible to score angiogram images according to the latest Gensini scoring criteria [ 36 ] or to use other scoring metrics, such as the SYNTAX score [ 37 ], to assess the severity of CHD.
The use of a different scoring system may affect the results. In conclusion, b-HbA1c was positively associated with the severity of CHD and was a risk factor for adverse cardiovascular events in T2DM with CHD patients, but not an independent risk factor.
Whereas f-HbA1c was an independent risk factor. Hence b-HbA1c was an independent predictive factor of severe CHD, and f-HbA1c was an independent predictive factor of 3p-MACE.
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Prediction of the risk of cardiovascular mortality using a score that includes glucose as a risk factor. The DECODE study. Download references. Editorial assistance, in the form of language editing and correction, was provided by XpertScientific Editing and Consulting Services.
The MORGAM Project received funding from EU projects MORGAM Biomed, BMH4-CT , GenomEUtwin FP5, QLG2-CT , ENGAGE FP7, HEALTH-F , CHANCES FP7, HEALTH-F , BiomarCaRE FP7, HEALTH-F , euCanSHare Horizon , No. This has supported central coordination, workshops, and part of the activities of the MORGAM Data Center, the MORGAM Laboratories, and the MORGAM Participating Centers.
Open Access funding enabled and organized by Projekt DEAL. Christoph Sinning, Renate B. German Center for Cardiovascular Research DZHK , Partner Site Greifswald, Greifswald, Germany.
Department of Internal Medicine B, University of Medicine Greifswald, Greifswald, Germany. German Heart Center Munich, Technical University, Munich, Germany.
German Center for Cardiovascular Research DZHK , Partner Site Munich Heart Alliance, Munich, Germany. Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany. German Research Center for Environmental Health, Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany.
Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany. Division of Clinical Epidemiology and Ageing Research, German Cancer Research Center, Heidelberg, Germany.
Network Aging Research, University of Heidelberg, Heidelberg, Germany. Department of Medicine and Surgery, EPIMED Research Center, University of Insubria at Varese, Varese, Italy.
Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy. Finnish Institute for Health and Welfare, Division Public Health and Welfare, Helsinki, Finland. If your cholesterol is too high, then the extra fat in your blood sticks to the walls of your blood vessels.
Over time, this fat hardens and is known as plaque. Hard plaque can block up the blood vessels, which makes the space narrower and leaves less room for blood to flow. This is called arteriosclerosis or atherosclerosis and is the most common cause of a heart attack.
In the narrower space, blood flow slows down and causes some of the blood cells to group together and clot. If a blood clot breaks away, it will travel through your arteries and veins until it reaches a section too narrow to pass through, making it partially or completely blocked.
Not only does the blood struggle to flow through the blood vessels, but over time atherosclerosis makes the walls of your blood vessels more rigid and less elastic. This can lead to high blood pressure also called hypertension or make high blood pressure worse.
High blood pressure puts extra strain on your blood vessels too. Narrowing of the blood vessels can affect other parts of the body too, like your legs and feet.
Find out more about reducing your risk of serious foot problems. Getting your HbA1c, cholesterol and blood pressure checked at least once a year are part of the checks you should have if you have diabetes. You should be getting access to your diabetes healthcare checks as normal but if you are still experiencing delays or changes to your appointments as an impact of the coronavirus pandemic we advise that you speak to your healthcare team and ask when these will be happening again.
By managing these three things, you'll be helping to manage your diabetes and protecting yourself against heart complications.
People with prediabetes and Type 2 Cauliflower mash recipe are more likely cardikvascular have HbAc impact on cardiovascular health blood cholesterolhigh blood pressureand high blood sugar. They are also cardjovascular to be overweight or obese. All of these factors increase the risk of developing cardiovascular disease and other serious health complications. If you have prediabetes or diabetes, it's crucial to monitor blood cholesterol, blood pressure, blood sugarand weight. Maybe you aren't experiencing any symptoms. Why is monitoring these numbers still important? HbAc impact on cardiovascular health -
Plaque is made of cholesterol deposits, which make the inside of arteries narrow and decrease blood flow. This process is called atherosclerosis, or hardening of the arteries.
Decreased blood flow to the heart can cause a heart attack. Decreased blood flow to the brain can cause a stroke. Hardening of the arteries can happen in other parts of the body too. PAD is often the first sign that a person with diabetes has cardiovascular disease. Over time, high blood sugar can damage blood vessels and the nerves that control your heart.
People with diabetes are also more likely to have other conditions that raise the risk for heart disease:. None of these conditions has symptoms. Your doctor can check your blood pressure and do a simple blood test to see if your LDL, HDL, and triglyceride levels are high.
People with diabetes are also more likely to have heart failure. This can lead to swelling in your legs and fluid building up in your lungs, making it hard to breathe.
Heart failure tends to get worse over time, but early diagnosis and treatment can help relieve symptoms and stop or delay the condition getting worse. Your blood pressure, cholesterol levels, and weight will help your doctor understand your overall risk for heart disease. Your doctor may also recommend other tests to check your heart health, which could include:.
These lifestyle changes can help lower your risk for heart disease or keep it from getting worse, as well as help you manage diabetes:. Your doctor may also prescribe medicines that can help keep your blood sugar, blood pressure, cholesterol, and triglycerides close to your target levels.
Work with a diabetes care and education specialist for help avoiding health complications such as heart disease. Find out more about how diabetes education can help you take the best care of yourself.
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Diabetes and Your Heart. Español Spanish. Minus Related Pages. The Gensini score was calculated by two clinicians independently, under the guidance of a cardiologist, following the Gensini score guidelines [ 10 ].
Step 1 is to calculate the severity score of the coronary lesion, step 2 is to apply a multiplication factor to each lesion score based upon the location of the lesion in the coronary tree, and step 3 is to sum the lesion severity scores.
The detailed calculation of the Gensini score was shown in Additional file 1 : Table S1. During hospitalization for CAG, baseline characteristics were collected.
Demographic information such as age, sex, and body mass index BMI was written. Medical histories such as hypertension, stroke, and related medication were recorded. Laboratory tests such as HbA1c, fasting serum glucose FSG , and fasting total cholesterol TC were analyzed.
Coronary angiography results and type of coronary artery disease were consulted. HbA1c was measured by High-Performance Liquid Chromatography HPLC. Some patients would be excluded if they have any condition shortening erythrocyte survival or decreasing mean erythrocyte age e.
Follow-up was begun after patients underwent CAG and ended in February Patients were followed up via the electronic medical record system or telephone, and laboratory tests and outcome events during the follow-up period were recorded.
The primary outcome was the 3-points MACE 3p-MACE , defined as cardiovascular death, nonfatal stroke, and nonfatal myocardial infarction. The definition of nonfatal stroke refers to ischemic and hemorrhagic strokes [ 12 ].
Nonfatal myocardial infarction is an acute myocardial infarction AMI that does not result in death. AMI is the presence of acute myocardial injury detected by abnormal cardiac biomarkers in the setting of evidence of acute myocardial ischemia [ 11 ].
Laboratory indicators for follow-up included HbA1c, TC, Triglyceride TG , High-density lipoprotein cholesterol HDL-C , Low-density lipoprotein cholesterol LDL-C , and microalbuminuria MAU.
Baseline and follow-up demographic and clinical characteristics were compared with the Pearson χ2 test for categorical variables and analysis of variance for continuous variables. Correlations between two continuous variables were analyzed using Spearman's correlation analysis.
The correlation between two ranked variables was assessed using Spearman's Rank Correlation. Patients with mild and moderate CHD were categorized into non-severe CHD groups, thus dividing patients into severe and non-severe CHD groups.
Binary logistic regression and ordered logistic regression analyses were used to assess the association of b-HbA1c as a continuous and categorical variable with severe CHD, respectively. To evaluate other risk factors of the severity of coronary artery disease, we included the baseline indicators in Table 1 in logistic regression one by one.
The independent risk of HbA1c b-HbA1c and f-HbA1c and insulin therapy for 3p-MACE was assessed by age, sex, and history of hypertension in a multivariate cox proportional risk model. Interactions between f-HbA1c and insulin therapy on 3p-MACE outcomes were assessed in a cox model.
For each patient, person-months of follow-up were counted from the date of diagnosis of CHD to the date of diagnosis of 3p-MACE or February , whichever came first. Therefore, AMI and stroke leading to death were not counted in the 17 nonfatal strokes and 15 nonfatal infarction events.
To analyze the effect of f-HbA1c on 3p-MACE, cumulative event incidence estimates were plotted according to f-HbA1c levels using the Kaplan—Meier technique. Differences between event-free curves were assessed with the log-rank test. SPSS software IBM SPSS Statistics 23 and R software R 3.
A total of patients with both T2DM and CHD were included through the hospital medical database. Ultimately, subjects were included in the study analysis.
Flow chart of the recruitment procedure. T2DM: type 2 diabetes mellitus; CHD: coronary heart disease; CAG: coronary angiography. The mean follow-up period was 24 months, and 31 patients Compared with the event-free patient group, b-HbA1c levels 8.
Among these patients, As b-HbA1c levels increased, Gensini scores tended to increase. The severity of CHD increased gradually with b-HbA1c.
Distribution characteristics of b-HbA1c and severity of CHD. The distribution characteristics of b-HbA1c and CHD severity in the patients revealed a strong correlation. By plotting the curve fit between b-HbA1c and the Gensini score Fig.
Additionally, duration of diabetes, fasting glucose, LDL-C, and BNP were risk factors for severe CHD, as shown in Additional file 1 : Table S2. Therefore, b-HbA1c could be considered a predictor of having severe CHD. The following items were included as covariates in the multifactorial logistic regression analysis: demographic factors age, sex, BMI , medical history hypertension, stroke, diabetes duration , laboratory tests on admission FBG, LDL-C, HDL-C, TG, CHOL, eGFR, BNP level in the multifactorial logistic regression analysis.
Age, sex and history of hypertension were adjusted in the multifactorial cox regression analysis. A subgroup analysis of the study population was performed to identify factors influencing the association between b-HbA1c and the risk of prevalence of 3p-MACE.
It showed that b-HbA1c was not a risk factor for the 3p-MACE in some subgroups e. A curve fit of f-HbA1c to 3p-MACE risk was plotted Fig. The cumulative incidence of 3p-MACE between groups with different f-HbA1c values was plotted Fig. It showed a significant difference in cumulative event rates between the two groups.
f-HbA1c and the risk of 3p-MACE. A Smoothed curve fit of f-HbA1c values and the risk of 3p-MACE; B Cumulative risk of 3p-MACE between groups with different f-HbA1c values. Interestingly, insulin treatment was strongly associated with the risk of 3p-MACE in these T2DM with CHD patients by cox regression analysis.
However, b-HbA1c and f-HbA1c were higher in the insulin-treated group than in the noninsulin-treated group Table 3.
Interactions between f-HbA1c and insulin therapy on 3p-MACE outcomes were assessed. The unadjusted HR was 1. This study found that patients with T2DM with poor glycemic control had a significantly increased risk of severe coronary stenosis compared to those with good glycemic control.
b-HbA1c was a risk factor but not an independent risk factor for the 3p-MACE in T2DM with CHD patients. In contrast, f-HbA1c was an independent risk factor for 3p-MACE in these patients.
T2DM promotes the development and progression of atherosclerosis, including not only traditional risk factors such as genetic factors, hyperglycemia, obesity, lipid metabolism disorders, sex hormone abnormalities, advanced age, and smoking but also nontraditional risk factors such as hyperinsulinemia, insulin resistance, diabetic hypercoagulable state, diabetic endothelial dysfunction, advanced glycosylation end products, oxidative stress, diabetic inflammation, microproteinuria, and hyperhomocysteinemia [ 13 ].
HbA1c is not only used to diagnose T2DM but can also be used to identify people at high cardiovascular risk. The higher the HbA1c level, the greater the risk of cardiovascular events in patients with T2DM [ 14 ]. Hyperglycaemia damages the cardiovascular system and induces atherosclerosis through several mechanisms, such as endothelial cell damage, oxidative stress, and imbalances in the coagulation and fibrinolytic systems, leading to diffuse coronary artery disease.
Although previous studies have shown a positive correlation between high levels of HbA1c and the severity of coronary artery disease, these have been limited to specific types of coronary artery disease [ 14 , 15 , 16 ].
The risk of b-HbA1c levels to coronary artery disease in a population of patients not differentiated by CHD type is currently unknown. This study assessed the severity of coronary lesions based on CAG using the Gensini score and found a positive correlation between b-HbA1c levels and the severity of coronary lesions, in line with previous studies [ 17 , 18 ].
The Gensini score is a scientific evaluation standard of coronary artery lesions, taking into account the number, location, and severity of stenosis of coronary artery lesions [ 10 ]. And it is a useful tool for assessing the severity of CHD [ 19 ].
Many studies have examined the prognostic impact of baseline blood glucose levels on patients with CHD. Still, most have been limited to patients with AMI or PCI, suggesting a positive association between b-HbA1c and poor prognosis [ 20 , 21 , 22 , 23 , 24 , 25 , 26 ].
b-HbA1c significantly predicted adverse cardiovascular events at prognosis [ 27 ]. A Chinese population-based study also showed no significant difference in prognosis between groups with different b-HbA1c levels in patients with T2DM combined with CHD who underwent PCI [ 28 ].
This study found that b-HbA1c was a risk factor for 3p-MACE in T2DM with CHD patients but was not an independent risk factor and was influenced by other factors such as age, duration of diabetes, hypertension, etc. Therefore, in patients with both T2DM and CHD, b-HbA1c alone cannot be used as an indicator to predict the long-term risk of 3p-MACE.
The prognosis of patients with CHD is closely related to glycemic control at follow-up. The poorer the glycemic control at follow-up and the need for insulin control, the higher the risk of developing 3p-MACE. It showed a higher incidence of 3p-MACE in the insulin-treated group.
Meanwhile, there was relatively poorer glycemic control in the insulin-treated group. The DIGAMI-2 study in found that intensive glycemic control reduced mortality in heart attack patients [ 29 ].
The subsequent DIGAMI-1 in found that glycemic control by insulin therapy significantly reduced 1-year mortality in patients with acute infarction compared to the conventional treatment group. This finding contradicts the results of this study [ 30 ]. We found the risk of 3p-MACE in patients with both T2DM and CHD increased with the higher f-HbA1c in the insulin treatment group.
In comparison, it was not significant in the patients without insulin treatment. And patients with f-HbA1c values above the national 8. The novelty of our study was that in addition to measuring the pre-CAG HbA1c as the level of the b-HbA1c value, the post-CAG HbA1c was also tested as the f-HbA1c.
Thus, it reflects not only the relationship between glycemic control before CAG and CHD severity but also the impact of different stages of glycemic control on the prognosis of patients with both T2DM and CHD.
Second, further threshold effect analyses were performed to determine which range of HbA1c was more likely to lead to severe CHD and adverse cardiovascular events and to guide clinicians in developing an individualized glycaemic management strategy for patients when b-HbA1c and f-HbA1c levels were found to correlate with the severity of coronary stenosis and the risk of 3p-MACE.
However, there were some limitations in this study. As this was a retrospective cohort study, much of the data were obtained from hospital databases or by reviewing patients' medical records, and some of the data were missing.
For example, there were no specific descriptions of smoking and drinking history, data on whether patients had been treated with statins before hospitalization were incomplete, and many patients did not have a urine albumin creatinine ratio, so these indicators were not included in the data analysis.
Smoking [ 32 ], alcohol history [ 33 ], statin treatment [ 34 ], and urine microalbumin [ 35 ] have been shown to be strongly associated with cardiovascular disease, so the absence of such data at baseline may have had some impact on the results.
As study excluded patients on tumor and renal failure dialysis at the time of inclusion, which significantly reduced the number of deaths of patients due to these causes, and only three deaths from other causes were observed at follow-up.
So the cox regression model did not include death from other causes as a competing risk, which may have affected the study results. Furthermore, as the assessment of coronary angiograms could only be based on what was available in the medical records, it was not possible to score angiogram images according to the latest Gensini scoring criteria [ 36 ] or to use other scoring metrics, such as the SYNTAX score [ 37 ], to assess the severity of CHD.
The use of a different scoring system may affect the results. In conclusion, b-HbA1c was positively associated with the severity of CHD and was a risk factor for adverse cardiovascular events in T2DM with CHD patients, but not an independent risk factor.
Whereas f-HbA1c was an independent risk factor. Hence b-HbA1c was an independent predictive factor of severe CHD, and f-HbA1c was an independent predictive factor of 3p-MACE.
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