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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EResults of an analysis of data from a healthcare database including nearly 70,000 patients with diabetes revealed that elevated HbA1C is a significant risk factor for acute myocardial infarction and the need for coronary artery bypass graft surgery.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Emyocardial infarction\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ehyperglycemia\/hypoglycemia\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ediabetes mellitus\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EResults of an analysis of data from a healthcare database including nearly 70,000 patients with diabetes revealed that elevated HbA1c is a significant risk factor for acute myocardial infarction (AMI) and the need for coronary artery bypass graft surgery (CABG).\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EIntroducing the analysis, Joseph E. Thomas, MD, Yale University School of Medicine, Connecticut, United States, said that while tight glycemic control has been associated with improved cardiovascular outcomes in both type 1 and type 2 diabetes, the relationship between glycemic control and cardiovascular outcomes in clinical practice is not well understood. Thomas and colleagues conducted a retrospective chart analysis of data from 69,418 patients with diabetes from the Integrated Health Care Information System (IHCIS).\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EFor purposes of the analysis, patients were stratified into four index HbA1c groups: \u0026lt;6%, 6\u20137%, 7\u20139%, \u22659%. Mean patient age was \u223c57 years (\u223c54% male), with prior AMI in 1.0\u20131.5% and prior CABG surgery in 0.1\u20130.5%. Mean follow-up was 27 months. In the HbA1c \u22659% group at baseline, total cholesterol, LDL-cholesterol, and triglycerides were higher, and HDL-cholesterol was lower than in the other groups. About a third of patients were receiving ACE inhibitors or angiotensin receptor blockers. As expected, use of oral antidiabetic agents and insulin was higher in patients with poorer glycemic control.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EThe unadjusted incidence rate for AMI, CABG, stroke, and their combination increased generally with increasing HbA1c with the exception of stroke (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E). \u201cWe were unable to explain the lower stroke incidence,\u201d Dr. Thomas said, although he commented that TIAs had been excluded.\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/10837\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/10837\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/10837\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1:\u003C\/span\u003E \n               \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EUnadjusted Incidence Rate per 1,000 Person-Years.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EAfter adjusting for baseline characteristics (gender, age, baseline hypertension, AMI, congestive heart failure, peripheral vascular disease, and cardiovascular disease), hazard ratios for survival and AMI increased with worsening glycemic control (HR=1.57 for HbA1c \u22659%, p\u0026lt;0.001) when compared with the baseline \u0026lt;6% HbA1c group. The same pattern persisted for survival and CABG (HR=1.19 for index HbA1c 6\u20137, HR=1.56 for index HbA1c 7\u20139, HR=1.38 for index HbA1c \u22659). With adjusted survival and stroke, however, differences were not significant.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EDr. Thomas concluded, \u201cElevated index HbA1c is a significant risk factor for AMI, CABG and poorer survival. Glycemic control is associated with real-world, long-term macrovascular outcomes.\u201d The data suggest, he added, that \u201cearly intervention with intensive diabetes treatment may reduce macrovascular risks.\u201d Finally, he noted that ongoing trials (ORIGIN, ACCORD, VADT) are addressing the potential benefits of insulin therapy in patients with cardiovascular disease.\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003ELimitations of this study include the fact that it was an observational study with short follow-up and that because the data were taken from the IHCIS managed care employee database, the population was likely to have been healthier and younger than the usual diabetes database.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2007 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/7\/6\/25.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzm85e\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzm85e\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}