Prognosis Varies Per Glycemic Index Pre-Revascularization

Type 2 diabetes patients with HbA1c of 6 to 7 percent have lowest risk of adverse cardio events
By Monica Smith
HealthDay Reporter

WEDNESDAY, May 5 (HealthDay News) -- Having a low -- but not too low -- glycemic index prior to surgery is optimal for best cardiovascular outcomes after coronary revascularization in patients with type 2 diabetes mellitus (DM), according to a study in the April 1 issue of the American Journal of Cardiology.

To evaluate what effect glycemic level has on cardiovascular outcomes following a first elective coronary revascularization, Natsuhiko Ehara, M.D., of the Kobe City Medical Center General Hospital in Japan, and colleagues compared the hemoglobin A1c (HbA1c) status of 1,504 patients with type 2 DM taking hypoglycemic agents.

The researchers found that 202 patients had a very low HbA1c level (less than 6 percent), 426 had a low HbA1c level (at least 6 but less than 7 percent), 405 had an intermediate HbA1c level (at least 7 but less than 8 percent), and 471 had a high HbA1c level (at least 8 percent). In multivariate analyses, those in the low HbA1c group had the lowest hazard ratio for major adverse cardiovascular events (MACE) compared with those without DM (hazard ratio, 1.13). In a multivariate analysis using the low group as a reference, patients with high HbA1c had a significantly greater risk of MACE, and patients with very low and intermediate HbA1c tended to be linked to increased risk for MACE.

"In conclusion, patients with type 2 DM treated with hypoglycemic agents and undergoing first elective coronary revascularization had significantly worse cardiovascular outcomes than patients without DM, except for patients with DM and a HbA1c of 6 to 7 percent. In the patients with DM, those with a HbA1c of 6 to 7 percent tended to have the lowest risk of MACE," the authors write.

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