Abstract 18861: Gender Differences in Hospitalization or Death Due to Heart Failure as Related to Glycemic Control in the ACCORD Trial
Background: Heart failure and type 2 diabetes (T2D) are important causes of hospitalizations and mortality. Heart failure is two and five times more common in T2D men and women, respectively, and is associated with a worse prognosis than in age-matched non-diabetics. The ACCORD trial (NCT00000620) tested the impact of intensive (targeted HbA1c <6.0%) vs. standard (targeted HbA1c 7.0%-7.9%) glucose-lowering treatment on cardiovascular events, including hospitalization or death due to heart failure (hdHF), in T2D patients (median baseline HbA1c 8.1%).
Methods: A secondary analysis of ACCORD patient-level data compared rates of hdHF by treatment arms across genders. We report event rates as Kaplan-Meier estimates and hazard ratios (95% CI) at 2.5, 5, and 7 years (end-of-trial).
Results: hdHF events occurred in 4.7% (298/6299) of men and 3.7% (146/3952) of women. With intensive treatment, the rate for hdHF events increased in men after 3.5 years, but the difference was not significant between genders across the entire observation period (log-rank p=0.428). With standard treatment, however, women had a significantly lower hdHF event rate compared to men across the entire study (log-rank p=0.007). In men (Figure 1A), event rates of the standard vs. intensive treatment did not differ significantly at any time point (log-rank p=0.974). In women (Figure 1B), intensive treatment was associated with a nonsignificant higher hdHF event rate (log-rank p=0.077). There was no gender by treatment interaction (p=0.150).
Conclusions: Unlike men, women with T2D tended to have an increased risk of hdHF events with intensive vs. standard glucose-lowering treatment in ACCORD. This interesting secondary analysis, without adjustments for baseline covariates or multiple comparisons, is hypothesis generating, and warrants confirmatory studies using patient-level data.
Disclaimer: The authors are solely responsible for the content (i.e., not NIH/FDA).
Author Disclosures: B. Tesfaldet: None. T. Patel: None. N. Amin: None. E. Navarro: None. H. Sviglin: None. R. Kirby: None. J. Chen: None. G. Csako: None. C. Gandotra: None. G. Sopko: None. L. Cooper: None. S. Coady: None. F. Pucino: None. K. Burkhart: None. H. Chang: None. P. Desvigne-Nickens: None. L. Liu: None. M. Fennessy: None. E. Leifer: None. S. Raman: None. Y. Rosenberg: None. A. Hasan: None.
- © 2016 by American Heart Association, Inc.