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Context:

Diabetes is an independent risk factor for heart failure (HF); however, it is not known whether tight glycemic control can reduce the occurrence of HF among diabetic patients.

Objective:

The aim of the study was to investigate the race-specific association of different levels of glycosylated hemoglobin (HbA1c) with the risk of HF among patients with diabetes.

Design, Setting, and Participants:

We prospectively investigated the race-specific association of different levels of HbA1c at baseline and during an average of 6.5 years of follow-up with incident HF risk among 17 181 African American and 12 446 white diabetic patients within the Louisiana State University Hospital System.

Main Outcome Measure:

We measured incident HF until May 31, 2012.

Results:

During follow-up, 5089 HF incident cases were identified. The multivariable-adjusted hazard ratios of HF associated with different levels of HbA1c at baseline (<6.0% [reference group], 6.0–6.9%, 7.0–7.9%, 8.0–8.9%, 9.0–9.9%, and ≥10.0%,) were 1.00, 1.02 (95% confidence interval, 0.91–1.15), 1.21 (1.05–1.38), 1.29 (1.12–1.50), 1.37 (1.17–1.61), and 1.49 (1.31–1.69) (P trend < .001) for African American diabetic patients, and 1.00, 1.09 (0.96–1.22), 1.09 (0.95–1.26), 1.43 (1.22–1.67), 1.49 (1.25–1.77), and 1.61 (1.38–1.87) (P trend < .001) for white diabetic patients, respectively. This graded positive association was also present in diabetic patients with and without glucose-lowering agent treatment; in diabetic patients with different age, gender, and smoking status; and in incident HF defined as systolic HF (ejection fraction ≤ 40%) and HF with a preserved ejection fraction (ejection fraction > 40%).

Conclusions:

The current study suggests a graded positive association of HbA1c with the risk of HF among both African American and white patients with diabetes.

Copyright © 2014 by The Endocrine Society
Issue Section:
JCEM Online: Brief Reports
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