Impact of Baseline Glycemic Control on Residual Cardiovascular Risk in Patients With Diabetes Mellitus and High‐Risk Vascular Disease Treated With Statin Therapy

• DOI: 10.1161/jaha.119.014328
• Publication Date: 2019-12-19T10:00:29Z
• Authors: Venu Menon; Anirudh Kumar; Divyang R. Patel; Julie St. John; Kathy E. Wolski; Ellen McErlean; Jeffrey S. Riesmeyer; Govinda Weerakkody; Giacomo Ruotolo; Paul C. Cremer; Stephen J. Nicholls; A. Michael Lincoff; Steven E. Nissen
• Keywords: Stroke; Unstable angina

Background The contemporary impact of glycemic control on patients with diabetes mellitus at high cardiovascular risk remains unclear. We evaluated the utility hemoglobin A1c (HbA1c) as a marker composite end point death, nonfatal myocardial infarction, stroke, hospitalization for unstable angina, and coronary revascularization in an optimally treated population established artery disease enrolled ACCELERATE (Assessment Clinical Effects Cholesteryl Ester Transfer Protein Inhibition With Evacetrapib Patients High Risk Vascular Outcomes) trial. Methods Results included all measured HbA1c (N=8145) estimated Kaplan-Meier (KM) events rates, stratified by increasing baseline levels censored 30 months. then performed multivariable regression primary point. Increasing was strongly associated occurrence (KM estimate, 12.6-18.2; P<0.001). also triple stroke 7.8-11.3; P=0.003) well individual points infarction 3.1-7.0; P<0.001), angina 1.8-5.0; P=0.003), 7.3-11.1; P=0.001), although not 1.4-2.4; P=0.45). rates mortality 2.6-4.3; P=0.21) all-cause 4.8-5.9; were similar regardless levels. When adjusting relevant characteristics, independent predictor (hazard ratio, 1.06; 95% CI, 1.02-1.11; P=0.003). Conclusions Glycemic control, HbA1c, independently outcomes high-risk statin therapy. Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT01687998.