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Association between Hemoglobin A1c and Stroke Risk in Patients with Type 2 Diabetes

BACKGROUND AND PURPOSE: The association between hemoglobin A1c (HbA1c) and stroke risk along with its subtypes is rarely reported. We aimed to investigate the association between HbA1c and the risk of incident stroke in patients with type 2 diabetes based on real world data from three healthcare sys...

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Autores principales: Shen, Yun, Shi, Lizheng, Nauman, Elizabeth, Katzmarzyk, Peter, Price-Haywood, Eboni, Bazzano, Alessandra, Nigam, Somesh, Hu, Gang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Stroke Society 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7005352/
https://www.ncbi.nlm.nih.gov/pubmed/32027794
http://dx.doi.org/10.5853/jos.2019.01704
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author Shen, Yun
Shi, Lizheng
Nauman, Elizabeth
Katzmarzyk, Peter
Price-Haywood, Eboni
Bazzano, Alessandra
Nigam, Somesh
Hu, Gang
author_facet Shen, Yun
Shi, Lizheng
Nauman, Elizabeth
Katzmarzyk, Peter
Price-Haywood, Eboni
Bazzano, Alessandra
Nigam, Somesh
Hu, Gang
author_sort Shen, Yun
collection PubMed
description BACKGROUND AND PURPOSE: The association between hemoglobin A1c (HbA1c) and stroke risk along with its subtypes is rarely reported. We aimed to investigate the association between HbA1c and the risk of incident stroke in patients with type 2 diabetes based on real world data from three healthcare systems. METHODS: We performed a retrospective cohort study of 27,113 African Americans and 40,431 whites with type 2 diabetes. Demographic, anthropometric, laboratory, and medication information were abstracted from the National Patient-Centered Clinical Research Network common data model. Incident stroke events including both ischemic and hemorrhagic stroke were defined. RESULTS: During a mean follow-up period of 3.79±1.68 years, 7,735 patients developed stroke (6,862 ischemic and 873 hemorrhagic). Multivariable-adjusted hazard ratios across levels of HbA1c at baseline (<6.0%, 6.0% to 6.9% [reference group], 7.0% to 7.9%, 8.0% to 8.9%, 9.0% to 9.9%, and ≥10%) were 1.07, 1.00, 1.13, 1.23, 1.27, and 1.37 (P(trend) <0.001) for total stroke, 1.02, 1.00, 1.13, 1.20, 1.24, and 1.35 (P(trend) <0.001) for ischemic stroke, and 1.40, 1.00, 1.14, 1.47, 1.47, and 1.51 (P(trend)=0.002) for hemorrhagic stroke. When we used an updated mean value of HbA1c, the U-shaped association of HbA1c with stroke risk did not change. This U-shaped association was consistent among patients of different subgroups. The U-shaped association was more pronounced among patients taking antidiabetic, lipid-lowering, and antihypertensive medications compared with those without these medications. CONCLUSIONS: These data suggest that diabetes management may have to be individualized according to the guideline recommendations rather than intensively attempting to lower HbA1c.
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spelling pubmed-70053522020-02-13 Association between Hemoglobin A1c and Stroke Risk in Patients with Type 2 Diabetes Shen, Yun Shi, Lizheng Nauman, Elizabeth Katzmarzyk, Peter Price-Haywood, Eboni Bazzano, Alessandra Nigam, Somesh Hu, Gang J Stroke Original Article BACKGROUND AND PURPOSE: The association between hemoglobin A1c (HbA1c) and stroke risk along with its subtypes is rarely reported. We aimed to investigate the association between HbA1c and the risk of incident stroke in patients with type 2 diabetes based on real world data from three healthcare systems. METHODS: We performed a retrospective cohort study of 27,113 African Americans and 40,431 whites with type 2 diabetes. Demographic, anthropometric, laboratory, and medication information were abstracted from the National Patient-Centered Clinical Research Network common data model. Incident stroke events including both ischemic and hemorrhagic stroke were defined. RESULTS: During a mean follow-up period of 3.79±1.68 years, 7,735 patients developed stroke (6,862 ischemic and 873 hemorrhagic). Multivariable-adjusted hazard ratios across levels of HbA1c at baseline (<6.0%, 6.0% to 6.9% [reference group], 7.0% to 7.9%, 8.0% to 8.9%, 9.0% to 9.9%, and ≥10%) were 1.07, 1.00, 1.13, 1.23, 1.27, and 1.37 (P(trend) <0.001) for total stroke, 1.02, 1.00, 1.13, 1.20, 1.24, and 1.35 (P(trend) <0.001) for ischemic stroke, and 1.40, 1.00, 1.14, 1.47, 1.47, and 1.51 (P(trend)=0.002) for hemorrhagic stroke. When we used an updated mean value of HbA1c, the U-shaped association of HbA1c with stroke risk did not change. This U-shaped association was consistent among patients of different subgroups. The U-shaped association was more pronounced among patients taking antidiabetic, lipid-lowering, and antihypertensive medications compared with those without these medications. CONCLUSIONS: These data suggest that diabetes management may have to be individualized according to the guideline recommendations rather than intensively attempting to lower HbA1c. Korean Stroke Society 2020-01 2020-01-31 /pmc/articles/PMC7005352/ /pubmed/32027794 http://dx.doi.org/10.5853/jos.2019.01704 Text en Copyright © 2020 Korean Stroke Society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Shen, Yun
Shi, Lizheng
Nauman, Elizabeth
Katzmarzyk, Peter
Price-Haywood, Eboni
Bazzano, Alessandra
Nigam, Somesh
Hu, Gang
Association between Hemoglobin A1c and Stroke Risk in Patients with Type 2 Diabetes
title Association between Hemoglobin A1c and Stroke Risk in Patients with Type 2 Diabetes
title_full Association between Hemoglobin A1c and Stroke Risk in Patients with Type 2 Diabetes
title_fullStr Association between Hemoglobin A1c and Stroke Risk in Patients with Type 2 Diabetes
title_full_unstemmed Association between Hemoglobin A1c and Stroke Risk in Patients with Type 2 Diabetes
title_short Association between Hemoglobin A1c and Stroke Risk in Patients with Type 2 Diabetes
title_sort association between hemoglobin a1c and stroke risk in patients with type 2 diabetes
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7005352/
https://www.ncbi.nlm.nih.gov/pubmed/32027794
http://dx.doi.org/10.5853/jos.2019.01704
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