The relationship between dysglycaemia and cardiovascular and renal risk in diabetic and non-diabetic participants in the HOPE study: a prospective epidemiological analysis
Open accessAbstract
Aims/hypothesis Emerging data suggest that different indices of glycaemia are risk factors for clinical events. The aim of this analysis was to investigate the relationship between fasting plasma glucose or glycated haemoglobin (GHb) levels and incident cardiovascular (CV) outcomes, death, heart failure and overt nephropathy in diabetic and non-diabetic individuals enrolled in the Heart Outcomes Prevention Evaluation (HOPE) study. Materials and methods The adjusted 4.5-year risk of CV events (myocardial infarction or stroke or CV death), heart failure, death and overt nephropathy was analysed in relation to baseline and updated GHb levels (in 3,529 diabetic HOPE study participants) and baseline fasting plasma glucose levels (in 1,937 non-diabetic and 1,013 diabetic participants). Results In diabetic participants, a 1% absolute rise in the updated GHb predicted future CV events (relative risk [RR]=1.07, 95% CI 1.01-1.13; p=0.014), death (RR=1.12, 95% CI 1.05-1.19; p=0.0004), heart failure (RR=1.20, 95% CI 1.08-1.33; p=0.0008) and overt nephropathy (RR=1.26, 95% CI 1.17-1.36; p<0.0001) after adjusting for age, sex, diabetes duration, blood pressure, WHR, hyperlipidaemia and ramipril. Similarly, a 1 mmol/l rise in fasting plasma glucose was related to an increased risk of CV outcomes (RR=1.09, 95% CI 1.05-1.13; p<0.0001), death (RR=1.06, 95% CI 1.01-1.12; p=0.017), heart failure (RR=1.16, 95% CI 1.06-1.13; p=0.0007) and overt nephropathy (RR=1.34, 95% CI 1.23-1.45; p<0.0001) in the group composed of diabetic and non-diabetic individuals. The significant relationship between fasting plasma glucose and CV outcomes persisted after adjustment for diabetes status (RR=1.06, 95% CI 1.00-1.12; p=0.043). Conclusions/interpretation There is an independent progressive relationship between indices of glycaemia and incident CV events, renal disease and death. Clinical trials of glucose lowering to prevent these outcomes in diabetic and non-diabetic individuals are indicated.
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Several epidemiological studies have reported an increased risk of death and cardiovascular disease with increased levels of glycated haemoglobin.
“Several epidemiological studies have reported an increased risk of death and cardiovascular disease with increased levels of glycated haemoglobin (haemoglobin A 1C ).[2][3][4]”
From The association between symptomatic, severe hypoglycaemia and mortality in type 2 diabetes: Retrospective epidemiological analysis of the ACCORD study (2010) · cites this paper as [3]
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- Authors
- Gerstein, H. C., Pogue, J., Mann, J. F. E., Lonn, E., Dagenais, G. R., McQueen, M., Yusuf, S., & HOPE investigators
- Affiliations
- Population Health Research Institute (CA)
- München Klinik Schwabing (DE)
- Université Laval (CA)
- Corresponding author
- Gerstein, H. C.
- Venue
- Diabetologia
- Published
- 2005-07-30
- Volume
- 48
- Issue
- 9
- Pages
- 1749-1755
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- OpenAlex
- W1974180544
- Cited by
- 262
- References
- 3
- Citations by year
- 2025: 3 · 2024: 5 · 2023: 14 · 2022: 11 · 2021: 12 · 2020: 7 · 2019: 13 · 2018: 11 · 2017: 17 · 2016: 12 · 2015: 21 · 2014: 14 · 2013: 15 · 2012: 22
- FWCI
- 6.76
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Diabetologia (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Eli Lilly and Company
- Novo Nordisk
- Medical Research Council Canada
- Medical Research Council
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- dysglycemia, HbA1c, fasting blood glucose, cardiovascular risk, heart failure, mortality, myocardial infarction, stroke, diabetes mellitus, ramipril, glycemic control, cardiovascular events, renal outcomes
- MeSH terms
- Angiotensin-Converting Enzyme Inhibitors, Blood Glucose, Cardiovascular Diseases, Diabetes Mellitus, Diabetic Angiopathies, Fasting, Female, Glycated Hemoglobin, Humans, Kidney Diseases, Male, Placebos, Reference Values, Risk Factors, Vitamin E, Ramipril
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