Lifestyle, Glycosylated Hemoglobin A1c, and Survival Among Patients With Stable Ischemic Heart Disease and Diabetes.

MedStar author(s):
Citation: Journal of the American College of Cardiology. 73(16):2049-2058, 2019 04 30.PMID: 31023428Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Diabetes Mellitus, Type 2/dt [Drug Therapy] | *Diabetes Mellitus, Type 2/ep [Epidemiology] | *Glycated Hemoglobin A/an [Analysis] | *Life Style | *Myocardial Ischemia/dt [Drug Therapy] | *Myocardial Ischemia/ep [Epidemiology] | Aged | Cardiovascular Agents/tu [Therapeutic Use] | Cause of Death | Comorbidity | Diabetes Mellitus, Type 2/di [Diagnosis] | Female | Humans | Hypoglycemic Agents/tu [Therapeutic Use] | Male | Middle Aged | Myocardial Ischemia/di [Diagnosis] | Prognosis | Proportional Hazards Models | Risk Assessment | Survival AnalysisYear: 2019Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007ISSN:
  • 0735-1097
Name of journal: Journal of the American College of CardiologyAbstract: BACKGROUND: The importance of glycosylated hemoglobin A1c (A1c) control as part of comprehensive risk factor management in patients with stable ischemic heart disease (SIHD) and diabetes mellitus (DM) is controversial.CONCLUSIONS: In this high-risk subset of SIHD patients with DM, the number of controlled risk factors, particularly lifestyle behaviors and A1c, were associated with improved survival. (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation; NCT00007657).Copyright (c) 2019 American College of Cardiology Foundation. All rights reserved.METHODS: Of 690 patients with DM followed in the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial, 592 (86%) had complete ascertainment of 7 pre-specified risk factors at baseline and after 1 year: systolic blood pressure, low-density lipoprotein cholesterol, nonsmoking, physical activity, diet adherence, body mass index, and A1c. The primary outcome measure was mortality beyond 1 year after randomization.OBJECTIVES: The purpose of this study was to determine whether a greater number of controlled risk factors at 1 year, including A1c, affects survival in patients with DM and SIHD.RESULTS: During a mean follow-up of 7.0 +/- 4.2 years beyond 1 year after randomization, 186 subjects died (31.4% overall, 4.5%/year). The greater the number of risk factors controlled at 1 year, the higher the probability of survival (unadjusted log rank p = 0.002). Compared with 0 to 1 controlled risk factors, attaining 3 to 7 goals predicted progressively lower mortality (hazard ratio for control of 6 or 7 risk factors was 0.13; 95% confidence interval: 0.05 to 0.40). Importantly, only 10.3% of subjects achieved control of 6 or 7 risk factors. In multivariate analysis, the strongest predictors of improved survival were no smoking, regular physical activity, dietary adherence, and A1c <7%.All authors: Berman DS, Boden WE, COURAGE Trial Research Group, Hartigan PM, Kostuk WJ, Mancini GBJ, Maron DJ, Spertus JA, Teo KK, Weintraub WSOriginally published: Journal of the American College of Cardiology. 73(16):2049-2058, 2019 Apr 30.Fiscal year: FY2019Digital Object Identifier: Date added to catalog: 2019-05-21
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 31023428 Available 31023428

Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007

BACKGROUND: The importance of glycosylated hemoglobin A1c (A1c) control as part of comprehensive risk factor management in patients with stable ischemic heart disease (SIHD) and diabetes mellitus (DM) is controversial.

CONCLUSIONS: In this high-risk subset of SIHD patients with DM, the number of controlled risk factors, particularly lifestyle behaviors and A1c, were associated with improved survival. (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation; NCT00007657).

Copyright (c) 2019 American College of Cardiology Foundation. All rights reserved.

METHODS: Of 690 patients with DM followed in the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial, 592 (86%) had complete ascertainment of 7 pre-specified risk factors at baseline and after 1 year: systolic blood pressure, low-density lipoprotein cholesterol, nonsmoking, physical activity, diet adherence, body mass index, and A1c. The primary outcome measure was mortality beyond 1 year after randomization.

OBJECTIVES: The purpose of this study was to determine whether a greater number of controlled risk factors at 1 year, including A1c, affects survival in patients with DM and SIHD.

RESULTS: During a mean follow-up of 7.0 +/- 4.2 years beyond 1 year after randomization, 186 subjects died (31.4% overall, 4.5%/year). The greater the number of risk factors controlled at 1 year, the higher the probability of survival (unadjusted log rank p = 0.002). Compared with 0 to 1 controlled risk factors, attaining 3 to 7 goals predicted progressively lower mortality (hazard ratio for control of 6 or 7 risk factors was 0.13; 95% confidence interval: 0.05 to 0.40). Importantly, only 10.3% of subjects achieved control of 6 or 7 risk factors. In multivariate analysis, the strongest predictors of improved survival were no smoking, regular physical activity, dietary adherence, and A1c <7%.

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