Relationship of Glycemia to Cardiovascular Disease ... - Lipids Online

UKPDS: Hemoglobin A 1c and Rates for Myocardial
Infarction and Microvascular Complications
Adjusted Incidence per
1,000 Person Years (%)
80
60
40
20
Myocardial infarction
Microvascular endpoints
0
5 6 7 8 9 10 11
Updated Mean HbA 1c Concentration
HbA 1c = hemoglobin A 1c (glycosylated)
UKPDS = United Kingdom Prospective Diabetes Study
Stratton IM, et al. BMJ. 2000;321:405–412; reproduced
with permission from the BMJ Publishing Group.
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www.lipidsonline.org
UKPDS: Hemoglobin A 1c and Rates for Myocardial Infarction and Microvascular
Complications
In United Kingdom Prospective Diabetes Study, which examined the updated mean
hemoglobin A 1c (HbA 1c ) on treatment and the incidence of both myocardial infarction
(MI) and microvascular endpoints, there were graded increases across glycemia for the
risk of these end-organ complications. The risk of microvascular disease was much
greater than the risk for MI at the same HbA 1c concentration. These data support
observations, over the years, that reductions in HbA 1c with treatment could produce
robust decreases in microvascular endpoints. The slope of the curve of glycemic control
related to MI risk is not as steep, indicating that if intervention is to be successful in
reducing MI risk, then larger decreases in HbA 1c may be required. Of note is the fact that
across the range of HbA 1c concentrations from 5.5% to 9.5%, the absolute risk for MI
was greater than the risk for the development of microvascular disease. The mechanism
by which glycemia increases risk for vascular disease has been the subject of intense
scrutiny.
Reference:
Stratton IM, Adler AI, Neil HA, et al. Association of glycaemia with macrovascular and
microvascular complications of type 2 diabetes (UKPDS 35): prospective observational
study. BMJ. 2000;321:405-412.
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