Forskning
Udskriv Udskriv
Switch language
Rigshospitalet - en del af Københavns Universitetshospital
Udgivet

Early glycaemic changes after initiation of oral antidiabetic medication and risk of major adverse cardiovascular events: results from a large primary care population of patients with type 2 diabetes

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

DOI

  1. Ticagrelor and the risk of Staphylococcus aureus bacteraemia and other infections

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  2. Haematuria and urinary tract cancers in patients with atrial fibrillation treated with oral anticoagulants

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  3. Patient-Reported Outcomes and Medication Adherence in Patients with Heart Failure

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  4. Assessing absolute stroke risk in patients with atrial fibrillation using a risk factor based approach

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  1. Incidence rates of dilated cardiomyopathy in adult first-degree relatives versus matched controls

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  2. Early Coronary Atherosclerosis in Women With Previous Preeclampsia

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  3. COVID-19 mRNA vaccination and myocarditis or pericarditis

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Vis graf over relationer

AIMS: To determine the risk of major adverse cardiovascular events (MACE) and death, associated with an early large and rapid decline in glycated haemoglobin (HbA1C) following first time initiation of an oral antidiabetic drug (OAD).

METHODS AND RESULTS: We included 10 518 primary care patients with type 2 diabetes, who initiated an OAD for the first time. For each individual, we measured a decline in HbA1C, as the difference between the pre-treatment HbA1C (within 3 months before OAD initiation) and the post-treatment HbA1C (within 1.5-4.5 months after OAD initiation), divided by the time between the two measurements. The decline was reported in mmol/mol change per 3 months in HbA1C and categorized by the median decline into levels of steep [≥9 mmol/mol (≥0.8%)] and flat decline [<9 mmol/mol per 3 months (<0.8%)]. Pre-treatment HbA1C was categorized by the median, into levels of low (48-62 mmol/mol) and high (>62 mmol/mol). Multiple Cox regression was used to study the effect of decline (steep vs. flat) on the outcome hazard rates separately for patients with low and high pre-treatment HbA1C. Analyses were adjusted for age, sex, traditional cardiovascular risk factors, severe comorbidities, and concomitant medication treatment. During a median follow-up time of 7.7 years, 1625 developed MACE and 2323 died. We found that a steep decline vs. a flat decline was significantly associated with a decreased hazard for MACE, both in individuals with high [hazard ratio (HR) 0.81; 95% confidence interval (CI) 0.69-0.94; P = 0.005] and low pre-treatment HbA1C (HR 0.79; 95% CI 0.66-0.96; P = 0.015). The hazard of MACE was more pronounced on the short-term vs. long-term in individuals with high pre-treatment HbA1C. We found no significant association between combinations of pre-treatment HbA1C and decline categories and hazard of all-cause mortality. However, a combination of a low pre-treatment HbA1C and steep decline was associated with increased 1-year mortality (HR 1.52; 95% CI 1.00-2.29; P = 0.048) and hypoglycaemia (HR 1.82; 95% CI 1.11-2.98; P = 0.017).

CONCLUSION: A combination of a high pre-treatment HbA1C and a steep decline in HbA1C was associated with a decreased short-term risk of MACE. A low pre-treatment HbA1C and a steep decline was associated with a long-term reduced risk of MACE, but a short-term increased risk of death and hypoglycaemia.

OriginalsprogEngelsk
Artikelnummerpvaa072
TidsskriftEuropean heart journal. Cardiovascular pharmacotherapy
Vol/bind7
Udgave nummer6
Sider (fra-til)486-495
Antal sider10
ISSN2055-6837
DOI
StatusUdgivet - nov. 2021

Bibliografisk note

© Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2020. For permissions, please email: journals.permissions@oup.com.

ID: 60258773