Abstract 16051: Tight Glyemic Control Reduces Cardiovascular Events In Diabetics With Haptoglobin 2-2 Genotype
Introduction: Several recent trials do not support the practice of tight glycemic control for patients with type 2 diabetes (DM). Other studies have demonstrated that individuals with DM and the haptoglobin (Hp) 2-2 genotype are at increased risk for cardiovascular events.
Hypothesis: The effect of glyemic control on cardiovascular events in DM individuals is related to their Hp genotype; namely, tight glycemic control may reduce the incidence of cardiovascular events in Hp 2–2 DM individuals whereas in non Hp 2–2 DM individuals it may provide little or no benefit.
Methods: An analytic cohort of 2277 Hp genotypes DM individuals were drawn from 47 primary care practices. This cohort was followed prospectively for 4.75 years for hard Coronary Heart Disease (CHD) outcomes (non-fatal MI or CVD death). All treatment decisions regarding routine care remained at the discretion of the individual's primary care physician. Tight glycemic control (HgbA1c <7 for at least 60% of readings during the follow-up period), was determined at baseline and over time. Multiple variable proportional hazard modeling, adjusting for established CHD risk factors, evaluated whether glycemic control combined with Hp genotype prospectively identified association with hard CHD.
Results: There were 88 hard CHD outcomes. Hp genotype distribution was 1502 (66%) non Hp 2–2 and 775 (34%) Hp 2–2. Individuals with Hp 2–2 and tight glycemic control had statistically significant reduced risk of developing CHD, HR=0.48, 95% CI (0.24–0.96), p= 0.037 compared with Hp 2–2 individuals with lesser glycemic control. Individuals with non - Hp 2–2 and tight gylcemic control had a non-statistically significant lower risk of developing CHD, HR=0.80, 95% CI (0.44–1.47), p= 0.471 compared to the less glycemic control non Hp 2-2 individuals.
Conclusions: It appears that tight glycemic control may provide cardiovascular benefit differentially to Hp 2–2 DM individuals compared to other genotypes. The cohort's nature, in which treatment decisions regarding routine care remained at the discretion of the individual's primary care physician, enhances its external validity. If replicated in other prospective studies, this may allow for a personalized medicine approach to these high risk individuals.
- © 2010 by American Heart Association, Inc.