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The Hemoglobin A1c Level as a Progressive Risk Factor for Cardiovascular Death, Hospitalization for Heart Failure, or Death in Patients With Chronic Heart Failure: An Analysis of the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) Program
Abstract
BACKGROUND: A progressive relationship between hemoglobin A(1c) (HbA(1c)) levels and cardiovascular (CV) events has been observed in persons with and without diabetes. To our knowledge, the nature of such a relationship in patients with symptomatic chronic heart failure (HF) has not been studied. METHODS: A total of 2412 participants (907 with prior diabetes) in the Candesartan in Heart failure: Assessment of Reduction in Mortality and Morbidity (CHARM) program with at least 1 HbA(1c) level were followed up for a median of 34 months. The incidence of the primary outcome (CV death or HF hospitalization), CV death, and total mortality was calculated according to eighths of the usual HbA(1c) level ranging from 5.8% or less to greater than 8.6%. Adjusted and unadjusted hazard ratios per 1% rise in HbA(1c) levels were also calculated. RESULTS: A total of 99.6% of eligible participants were followed up until they developed an outcome or the study finished. The risk of the primary composite outcome, CV death, hospitalization for worsening HF, and total mortality rose progressively with higher levels of usual HbA(1c) (P for trend <.001). After age and sex were adjusted for, hazards of these outcomes per 1% higher HbA(1c) level were 1.25 (95% confidence interval [CI ], 1.20-1.31), 1.24 (95% CI, 1.17-1.31), 1.25 (95% CI, 1.19-1.31), and 1.22 (95% CI, 1.16-1.29), respectively. This relationship was evident in patients with and without diabetes and with reduced or preserved ejection fraction and persisted after adjustment for diabetes, other risk factors, and allocation to candesartan. CONCLUSION: In diabetic and nondiabetic patients with symptomatic chronic HF, the HbA(1c) level is an independent progressive risk factor for CV death, hospitalization for HF, and total mortality.
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“In the CHARM trial, high HbA 1c was associated with increased all-cause and CV mortality in patients with T2DM and both HFrEF and HFpEF.104”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [104]
In the citing paper
“A 1% increase in HbA 1c was associated with an increased HR of 1.1 for CV mortality.104”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [104]
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Metadata
- Authors
- Gerstein, H. C.
- Affiliations
- Population Health Research Institute (CA)
- Corresponding author
- Gerstein, Hertzel C.
- ORCID
- Gerstein, Hertzel C.
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2008-08-11
- Volume
- 168
- Issue
- 15
- Pages
- 1699
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W2164518074
- Cited by
- 217
- References
- 27
- Citations by year
- 2026: 5 · 2025: 3 · 2024: 5 · 2023: 6 · 2022: 17 · 2021: 12 · 2020: 11 · 2019: 10 · 2018: 16 · 2017: 17 · 2016: 20 · 2015: 17 · 2014: 11 · 2013: 7 · 2012: 17
- FWCI
- 10.39
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
- Funders
- AstraZeneca
- Heart and Stroke Foundation of Canada
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- HbA1c, chronic heart failure, cardiovascular mortality, heart failure hospitalization, all-cause mortality, glycemic control, diabetes mellitus, candesartan, risk factors, ejection fraction
- MeSH terms
- Aged, Cardiovascular Diseases, Chronic Disease, Diabetes Mellitus, Female, Follow-Up Studies, Heart Failure, Glycated Hemoglobin, Hospitalization, Humans, Male, Risk Factors
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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