Cited by 217Heart Failure Treatment and ManagementCardiovascular Function and Risk FactorsDiabetes, Cardiovascular Risks, and Lipoproteins

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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

Gerstein, Hertzel C.·2008·Archives of Internal Medicine

DOI 10.1001/archinte.168.15.1699

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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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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)
DOI: 10.1001/archinte.168.15.1699
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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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

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