Sweet and Salty: Hemoglobin A1c and Cardiovascular Events in Heart Failure
In a CHARM substudy, increased HbA1c levels were strongly associated with adverse outcomes in heart failure patients, whether or not they had diabetes.
A progressive association exists between increasing levels of hemoglobin A1c (HbA1c) and cardiovascular events in individuals with or without diabetes. The toxic effects of hyperglycemia may be especially harmful to an already struggling left ventricle, placing patients with heart failure at heightened risk for adverse events.
In a prespecified analysis of 2412 participants in the manufacturer-sponsored Candesartan in Heart failure: Assessment of Reduction in Mortality and Morbidity (CHARM) study, elevated HbA1c level was significantly associated with — and was an independent risk factor for — cardiovascular events or death. This association persisted even after adjustment for known diabetes, medication use, smoking, renal function, and other variables. In patients without diabetes, a 27% increase in risk for cardiovascular events or death (adjusted for age and sex) was found with each 1% increase in HbA1c level.
Comment: Although the link between hemoglobin A1c levels and cardiovascular events in heart failure is not fully understood, these findings expand its implications for patients, regardless of their diabetes status. Whether lowering glucose levels should be a goal of heart failure therapy is a clinically important question that remains to be answered.
Published in Journal Watch Cardiology September 10, 2008
Jennifer Zaranis
Independent Shaklee Distributor
www.shaklee.net/zaranis
