Age Matters: Study Finds Divergent Risks of HbA1c Levels in Diabetes Patients with Triple-Vessel Disease

The study, published in Diabetes Research and Clinical Practice, revealed variations in the relationship between HbA1c levels and endpoint events among patients with triple-vessel coronary disease and diabetes of different ages.

"In younger patients, increased HbA1c levels were associated with a higher risk of major adverse cardiovascular and cerebrovascular events (MACCE) and death, while in older patients, excessively low HbA1c levels (HbA1c < 6 %) tied to a higher risk of death and MACCE," the researchers reported.

Lei Song, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China, and colleagues aimed to investigate the correlation between HbA1c and adverse prognostic events in patients with diabetes and TVD.

This study included 2,051 patients with TVD and diabetes. Based on their HbA1c levels, the researchers categorized patients into five groups: <6.0 %, 6.0–6.4 %, 6.5–6.9 %, 7.0–7.9 %, and ≥ 8.0 %. The primary endpoint was all-cause death, and the secondary endpoint was MACCE.

The following were the key findings of the study:

· The median follow-up time was 5.88 years. During this period, the researchers recorded 15.7 % of all-cause deaths and 26.2 % MACCEs.

· The relationship between HbA1c and the risk of endpoint events showed a J-shaped pattern; the lowest risk was between 6.0 % and 6.4 %.

· Further analysis revealed a significant interaction between HbA1c and age.

· In the subgroup with age < 70 years, as HbA1c increased, the risk of endpoint events gradually rose.

· In the subgroup with age ≥70 years, there was an L-shaped relationship between HbA1c and endpoint events, with the highest risk observed in patients with HbA1c < 6.0 %.

The results suggest a need for age-specific glycemic targets in diabetic patients with extensive coronary artery disease. Younger patients may require stricter control to mitigate long-term risks, whereas older patients could benefit from more lenient targets to avoid hypoglycemic episodes.

As the global prevalence of diabetes continues to rise, fueled by lifestyle changes and aging populations, studies like this serve as crucial benchmarks for refining treatment guidelines. The researchers advocate for ongoing research to further elucidate the intricate interplay between glycemic control, age, and cardiovascular health, aiming to optimize outcomes for all diabetic patients facing complex coronary challenges.

Reference:

https://doi.org/10.1016/j.diabres.2024.111751