Early glycaemic changes after initiation of oral antidiabetic medication and risk of major adverse cardiovascular events: results from a large primary care population of patients with type2diabetes
Aims To determine the risk of major adverse cardiovascular events (MACE) and death, associated with an early large and rapid decline in glycated haemoglobin ([HbA.sub.1C]) following first time initiation of an oral antidiabetic drug (OAD). Methods and results We included 10 518 primary care patients...
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| Veröffentlicht in: | European heart journal. Cardiovascular pharmacotherapy 2021-11, Vol.7 (6), p.486 |
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| creator | Ghouse, Jonas Blanche, Paul Skov, Morten W Lind, Bent Vaag, Allan Kanters, Jorgen K Svendsen, Jesper H Kober, Lars Olesen, Morten S Gerds, Thomas A Holst, Anders G Nielsen, Jonas B |
| description | Aims To determine the risk of major adverse cardiovascular events (MACE) and death, associated with an early large and rapid decline in glycated haemoglobin ([HbA.sub.1C]) following first time initiation of an oral antidiabetic drug (OAD). Methods and results We included 10 518 primary care patients with type 2 diabetes, who initiated an OAD for the first time. For each individual, we measured a decline in [HbA.sub.1C], as the difference between the pre-treatment [HbA.sub.1C] (within 3months before OAD initiation) and the post-treatment [HbA.sub.1C] (within 1.5-4.5 months after OAD initiation), divided by the time between the two measurements. The decline was reported in mmol/mol change per 3months in [HbA.sub.1C] and categorized by the median decline into levels of steep [[greater than or equal to]9 mmol/mol ([greater than or equal to]0.8%)] and flat decline [ |
| doi_str_mv | 10.1093/ehjcvp/pvaa072 |
| format | Article |
| fullrecord | <record><control><sourceid>gale</sourceid><recordid>TN_cdi_gale_infotracmisc_A690097958</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A690097958</galeid><sourcerecordid>A690097958</sourcerecordid><originalsourceid>FETCH-LOGICAL-g678-4d45d043984cdde897f463e841bcedb9a2b748b81d793a42235b033dadf120b3</originalsourceid><addsrcrecordid>eNptkEtPwzAMx3sAiWnsytkS521p00fKbZrGQ5rEAe6Tm7hdRttUSVbUD8j3otVA4oB88Ov_sy0HwV3IViHL-ZqOJ9l3665HZFl0FcwiliTLVPDsJlg4d2KMhalII8FnwdcObT1AVQ8SqdES5BHbihxg6cmCbrXX6LVpwZRgLNaArddKY0F-VDektLz0sVVgtfuYhA2ejAVUPVlHINEqbXp08lyjBeqp9e4BLLlz7R2U1jSAMLYqgs7qBu0wMWNiupH43d6N0UTCp_ZH8ENH0eUOcrfBdYm1o8WPnwdvj7v37fNy__r0st3sl1WaiWWs4kSxmOcilkqRyLMyTjmJOCwkqSLHqMhiUYhQZTnHOIp4UjDOFaoyjFjB58H9ZWqFNR10WxpvUTbaycMmzRnLszwRo2r1j2o0Nf3XtFTqsf4H-AYPNo1K</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Early glycaemic changes after initiation of oral antidiabetic medication and risk of major adverse cardiovascular events: results from a large primary care population of patients with type2diabetes</title><source>Oxford University Press Journals All Titles (1996-Current)</source><source>Alma/SFX Local Collection</source><creator>Ghouse, Jonas ; Blanche, Paul ; Skov, Morten W ; Lind, Bent ; Vaag, Allan ; Kanters, Jorgen K ; Svendsen, Jesper H ; Kober, Lars ; Olesen, Morten S ; Gerds, Thomas A ; Holst, Anders G ; Nielsen, Jonas B</creator><creatorcontrib>Ghouse, Jonas ; Blanche, Paul ; Skov, Morten W ; Lind, Bent ; Vaag, Allan ; Kanters, Jorgen K ; Svendsen, Jesper H ; Kober, Lars ; Olesen, Morten S ; Gerds, Thomas A ; Holst, Anders G ; Nielsen, Jonas B</creatorcontrib><description>Aims To determine the risk of major adverse cardiovascular events (MACE) and death, associated with an early large and rapid decline in glycated haemoglobin ([HbA.sub.1C]) following first time initiation of an oral antidiabetic drug (OAD). Methods and results We included 10 518 primary care patients with type 2 diabetes, who initiated an OAD for the first time. For each individual, we measured a decline in [HbA.sub.1C], as the difference between the pre-treatment [HbA.sub.1C] (within 3months before OAD initiation) and the post-treatment [HbA.sub.1C] (within 1.5-4.5 months after OAD initiation), divided by the time between the two measurements. The decline was reported in mmol/mol change per 3months in [HbA.sub.1C] and categorized by the median decline into levels of steep [[greater than or equal to]9 mmol/mol ([greater than or equal to]0.8%)] and flat decline [<9 mmol/mol per 3 months (<0.8%)]. Pre-treatment [HbA.sub.1C] was categorized by the median, into levels of low (48-62 mmol/mol) and high (>62 mmol/mol). Multiple Cox regression was used to study the effect of decline (steep vs. flat) on the outcome hazard rates separately for patients with low and high pre-treatment [HbA.sub.1C]. Analyses were adjusted for age, sex, traditional cardiovascular risk factors, severe comorbidities, and concomitant medication treatment. During a median follow-up time of 7.7years, 1625 developed MACE and 2323 died. We found that a steep decline vs. a flat decline was significantly associated with a decreased hazard for MACE, both in individuals with high [hazard ratio (HR) 0.81; 95% confidence interval (CI) 0.69-0.94; P = 0.005] and low pre-treatment [HbA.sub.1C] (HR 0.79; 95% CI 0.66-0.96; P = 0.015). The hazard of MACE was more pronounced on the short-term vs. long-term in individuals with high pre-treatment [HbA.sub.1C]. We found no significant association between combinations of pre-treatment [HbA.sub.1C] and decline categories and hazard of all-cause mortality. However, a combination of a low pre-treatment [HbA.sub.1C] and steep decline was associated with increased 1-year mortality (HR 1.52; 95% CI 1.00-2.29; P = 0.048) and hypoglycaemia (HR 1.82; 95% CI 1.11-2.98; P = 0.017). Conclusion A combination of a high pre-treatment [HbA.sub.1C] and a steep decline in [HbA.sub.1C] was associated with a decreased short-term risk of MACE. A low pre-treatment [HbA.sub.1C] and a steep decline was associated with a long-term reduced risk of MACE, but a short-term increased risk of death and hypoglycaemia. Keywords Diabetes mellitus * Oral antidiabetic medication * Major adverse cardiovascular events * [HbA.sub.1C] * Intensive treatment</description><identifier>ISSN: 2055-6837</identifier><identifier>DOI: 10.1093/ehjcvp/pvaa072</identifier><language>eng</language><publisher>Oxford University Press</publisher><subject>Denmark ; Diabetes ; Drug therapy ; Glycosylated hemoglobin ; Health aspects ; Mortality ; Risk factors</subject><ispartof>European heart journal. Cardiovascular pharmacotherapy, 2021-11, Vol.7 (6), p.486</ispartof><rights>COPYRIGHT 2021 Oxford University Press</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,782,786,27933,27934</link.rule.ids></links><search><creatorcontrib>Ghouse, Jonas</creatorcontrib><creatorcontrib>Blanche, Paul</creatorcontrib><creatorcontrib>Skov, Morten W</creatorcontrib><creatorcontrib>Lind, Bent</creatorcontrib><creatorcontrib>Vaag, Allan</creatorcontrib><creatorcontrib>Kanters, Jorgen K</creatorcontrib><creatorcontrib>Svendsen, Jesper H</creatorcontrib><creatorcontrib>Kober, Lars</creatorcontrib><creatorcontrib>Olesen, Morten S</creatorcontrib><creatorcontrib>Gerds, Thomas A</creatorcontrib><creatorcontrib>Holst, Anders G</creatorcontrib><creatorcontrib>Nielsen, Jonas B</creatorcontrib><title>Early glycaemic changes after initiation of oral antidiabetic medication and risk of major adverse cardiovascular events: results from a large primary care population of patients with type2diabetes</title><title>European heart journal. Cardiovascular pharmacotherapy</title><description>Aims To determine the risk of major adverse cardiovascular events (MACE) and death, associated with an early large and rapid decline in glycated haemoglobin ([HbA.sub.1C]) following first time initiation of an oral antidiabetic drug (OAD). Methods and results We included 10 518 primary care patients with type 2 diabetes, who initiated an OAD for the first time. For each individual, we measured a decline in [HbA.sub.1C], as the difference between the pre-treatment [HbA.sub.1C] (within 3months before OAD initiation) and the post-treatment [HbA.sub.1C] (within 1.5-4.5 months after OAD initiation), divided by the time between the two measurements. The decline was reported in mmol/mol change per 3months in [HbA.sub.1C] and categorized by the median decline into levels of steep [[greater than or equal to]9 mmol/mol ([greater than or equal to]0.8%)] and flat decline [<9 mmol/mol per 3 months (<0.8%)]. Pre-treatment [HbA.sub.1C] was categorized by the median, into levels of low (48-62 mmol/mol) and high (>62 mmol/mol). Multiple Cox regression was used to study the effect of decline (steep vs. flat) on the outcome hazard rates separately for patients with low and high pre-treatment [HbA.sub.1C]. Analyses were adjusted for age, sex, traditional cardiovascular risk factors, severe comorbidities, and concomitant medication treatment. During a median follow-up time of 7.7years, 1625 developed MACE and 2323 died. We found that a steep decline vs. a flat decline was significantly associated with a decreased hazard for MACE, both in individuals with high [hazard ratio (HR) 0.81; 95% confidence interval (CI) 0.69-0.94; P = 0.005] and low pre-treatment [HbA.sub.1C] (HR 0.79; 95% CI 0.66-0.96; P = 0.015). The hazard of MACE was more pronounced on the short-term vs. long-term in individuals with high pre-treatment [HbA.sub.1C]. We found no significant association between combinations of pre-treatment [HbA.sub.1C] and decline categories and hazard of all-cause mortality. However, a combination of a low pre-treatment [HbA.sub.1C] and steep decline was associated with increased 1-year mortality (HR 1.52; 95% CI 1.00-2.29; P = 0.048) and hypoglycaemia (HR 1.82; 95% CI 1.11-2.98; P = 0.017). Conclusion A combination of a high pre-treatment [HbA.sub.1C] and a steep decline in [HbA.sub.1C] was associated with a decreased short-term risk of MACE. A low pre-treatment [HbA.sub.1C] and a steep decline was associated with a long-term reduced risk of MACE, but a short-term increased risk of death and hypoglycaemia. Keywords Diabetes mellitus * Oral antidiabetic medication * Major adverse cardiovascular events * [HbA.sub.1C] * Intensive treatment</description><subject>Denmark</subject><subject>Diabetes</subject><subject>Drug therapy</subject><subject>Glycosylated hemoglobin</subject><subject>Health aspects</subject><subject>Mortality</subject><subject>Risk factors</subject><issn>2055-6837</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid/><recordid>eNptkEtPwzAMx3sAiWnsytkS521p00fKbZrGQ5rEAe6Tm7hdRttUSVbUD8j3otVA4oB88Ov_sy0HwV3IViHL-ZqOJ9l3665HZFl0FcwiliTLVPDsJlg4d2KMhalII8FnwdcObT1AVQ8SqdES5BHbihxg6cmCbrXX6LVpwZRgLNaArddKY0F-VDektLz0sVVgtfuYhA2ejAVUPVlHINEqbXp08lyjBeqp9e4BLLlz7R2U1jSAMLYqgs7qBu0wMWNiupH43d6N0UTCp_ZH8ENH0eUOcrfBdYm1o8WPnwdvj7v37fNy__r0st3sl1WaiWWs4kSxmOcilkqRyLMyTjmJOCwkqSLHqMhiUYhQZTnHOIp4UjDOFaoyjFjB58H9ZWqFNR10WxpvUTbaycMmzRnLszwRo2r1j2o0Nf3XtFTqsf4H-AYPNo1K</recordid><startdate>20211101</startdate><enddate>20211101</enddate><creator>Ghouse, Jonas</creator><creator>Blanche, Paul</creator><creator>Skov, Morten W</creator><creator>Lind, Bent</creator><creator>Vaag, Allan</creator><creator>Kanters, Jorgen K</creator><creator>Svendsen, Jesper H</creator><creator>Kober, Lars</creator><creator>Olesen, Morten S</creator><creator>Gerds, Thomas A</creator><creator>Holst, Anders G</creator><creator>Nielsen, Jonas B</creator><general>Oxford University Press</general><scope/></search><sort><creationdate>20211101</creationdate><title>Early glycaemic changes after initiation of oral antidiabetic medication and risk of major adverse cardiovascular events: results from a large primary care population of patients with type2diabetes</title><author>Ghouse, Jonas ; Blanche, Paul ; Skov, Morten W ; Lind, Bent ; Vaag, Allan ; Kanters, Jorgen K ; Svendsen, Jesper H ; Kober, Lars ; Olesen, Morten S ; Gerds, Thomas A ; Holst, Anders G ; Nielsen, Jonas B</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-g678-4d45d043984cdde897f463e841bcedb9a2b748b81d793a42235b033dadf120b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Denmark</topic><topic>Diabetes</topic><topic>Drug therapy</topic><topic>Glycosylated hemoglobin</topic><topic>Health aspects</topic><topic>Mortality</topic><topic>Risk factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ghouse, Jonas</creatorcontrib><creatorcontrib>Blanche, Paul</creatorcontrib><creatorcontrib>Skov, Morten W</creatorcontrib><creatorcontrib>Lind, Bent</creatorcontrib><creatorcontrib>Vaag, Allan</creatorcontrib><creatorcontrib>Kanters, Jorgen K</creatorcontrib><creatorcontrib>Svendsen, Jesper H</creatorcontrib><creatorcontrib>Kober, Lars</creatorcontrib><creatorcontrib>Olesen, Morten S</creatorcontrib><creatorcontrib>Gerds, Thomas A</creatorcontrib><creatorcontrib>Holst, Anders G</creatorcontrib><creatorcontrib>Nielsen, Jonas B</creatorcontrib><jtitle>European heart journal. Cardiovascular pharmacotherapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ghouse, Jonas</au><au>Blanche, Paul</au><au>Skov, Morten W</au><au>Lind, Bent</au><au>Vaag, Allan</au><au>Kanters, Jorgen K</au><au>Svendsen, Jesper H</au><au>Kober, Lars</au><au>Olesen, Morten S</au><au>Gerds, Thomas A</au><au>Holst, Anders G</au><au>Nielsen, Jonas B</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early glycaemic changes after initiation of oral antidiabetic medication and risk of major adverse cardiovascular events: results from a large primary care population of patients with type2diabetes</atitle><jtitle>European heart journal. Cardiovascular pharmacotherapy</jtitle><date>2021-11-01</date><risdate>2021</risdate><volume>7</volume><issue>6</issue><spage>486</spage><pages>486-</pages><issn>2055-6837</issn><abstract>Aims To determine the risk of major adverse cardiovascular events (MACE) and death, associated with an early large and rapid decline in glycated haemoglobin ([HbA.sub.1C]) following first time initiation of an oral antidiabetic drug (OAD). Methods and results We included 10 518 primary care patients with type 2 diabetes, who initiated an OAD for the first time. For each individual, we measured a decline in [HbA.sub.1C], as the difference between the pre-treatment [HbA.sub.1C] (within 3months before OAD initiation) and the post-treatment [HbA.sub.1C] (within 1.5-4.5 months after OAD initiation), divided by the time between the two measurements. The decline was reported in mmol/mol change per 3months in [HbA.sub.1C] and categorized by the median decline into levels of steep [[greater than or equal to]9 mmol/mol ([greater than or equal to]0.8%)] and flat decline [<9 mmol/mol per 3 months (<0.8%)]. Pre-treatment [HbA.sub.1C] was categorized by the median, into levels of low (48-62 mmol/mol) and high (>62 mmol/mol). Multiple Cox regression was used to study the effect of decline (steep vs. flat) on the outcome hazard rates separately for patients with low and high pre-treatment [HbA.sub.1C]. Analyses were adjusted for age, sex, traditional cardiovascular risk factors, severe comorbidities, and concomitant medication treatment. During a median follow-up time of 7.7years, 1625 developed MACE and 2323 died. We found that a steep decline vs. a flat decline was significantly associated with a decreased hazard for MACE, both in individuals with high [hazard ratio (HR) 0.81; 95% confidence interval (CI) 0.69-0.94; P = 0.005] and low pre-treatment [HbA.sub.1C] (HR 0.79; 95% CI 0.66-0.96; P = 0.015). The hazard of MACE was more pronounced on the short-term vs. long-term in individuals with high pre-treatment [HbA.sub.1C]. We found no significant association between combinations of pre-treatment [HbA.sub.1C] and decline categories and hazard of all-cause mortality. However, a combination of a low pre-treatment [HbA.sub.1C] and steep decline was associated with increased 1-year mortality (HR 1.52; 95% CI 1.00-2.29; P = 0.048) and hypoglycaemia (HR 1.82; 95% CI 1.11-2.98; P = 0.017). Conclusion A combination of a high pre-treatment [HbA.sub.1C] and a steep decline in [HbA.sub.1C] was associated with a decreased short-term risk of MACE. A low pre-treatment [HbA.sub.1C] and a steep decline was associated with a long-term reduced risk of MACE, but a short-term increased risk of death and hypoglycaemia. Keywords Diabetes mellitus * Oral antidiabetic medication * Major adverse cardiovascular events * [HbA.sub.1C] * Intensive treatment</abstract><pub>Oxford University Press</pub><doi>10.1093/ehjcvp/pvaa072</doi></addata></record> |
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| ispartof | European heart journal. Cardiovascular pharmacotherapy, 2021-11, Vol.7 (6), p.486 |
| issn | 2055-6837 |
| language | eng |
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| source | Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection |
| subjects | Denmark Diabetes Drug therapy Glycosylated hemoglobin Health aspects Mortality Risk factors |
| title | Early glycaemic changes after initiation of oral antidiabetic medication and risk of major adverse cardiovascular events: results from a large primary care population of patients with type2diabetes |
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