Aortic Stenosis Progression Linked to Higher A1c Levels

Miriam E. Tucker, for Medscape

March 15, 2022

Researchers published the study covered in this summary on Research Square as a preprint that has not yet been peer reviewed.

Key Takeaways

  • In patients with mild or moderate aortic stenosis (AS), higher A1c levels were significantly associated with a faster rate of AS progression.

Why This Matters

  • Although the association between diabetes and accelerated AS progression is well-established, no study previously investigated the association between degree of glycemic control and the rate of AS progression.

  • The authors said that their findings further highlight the importance of glycemic control in patients with diabetes and mild to moderate AS.

  • More intensive glycemic control might minimize AS progression in patients with diabetes and mild to moderate AS.

Study Design

  • A retrospective, observational study of 1366 patients at a single academic center in the South Korea with mild to moderate AS. The patients all had a follow-up echocardiography examination of the aortic valve performed at least 6 months after the baseline assessment (median follow-up time, 18.4 months).

  • The study analyzed patients seen from 2003-2019; the median age of the cohort was 74 years.

  • The study cohort included 1037 patients without diabetes (median A1c of 5.8%), 186 patients with diabetes and an A1c level at baseline of less than 7% (median A1c of 6.4%), and 143 patients with diabetes and an A1c at baseline of at least 7% (median A1c of 7.6%)

  • The study’s primary outcome was the AS progression over time as measured by the annualized change in peak velocity of blood through the aortic valve.

Key Results

  • The AS progression rate was significantly proportional to A1c level at baseline, with a more rapid rate of progression in those with a higher baseline A1c.

  • In a multivariable logistic regression analysis, mean A1c level at baseline was significantly associated with accelerated AS progression, with an adjusted 27% increased rate of faster AS progression for each 1 percentage point increase in baseline A1c.

  • When the authors analyzed A1c as a categorical variable, an A1c of 7% or higher at baseline significantly linked with an adjusted 52% increased rate of accelerated AS progression compared with people with an A1c of less than 7% at baseline.

Limitations

  • The study had a retrospective cohort design and hence can't establish causation.

  • Information was missing on the antidiabetes agents used by patients in the study, and so the authors could not assess the relationship between differences in AS progression and the diabetes treatments that patients received.

  • The study focused only on echocardiographic measures of AS but did not consider changes in aortic valve calcification or inflammation measured by CT scan or nuclear imaging.

  • The study focused exclusively on patients with mild-moderate AS and so the findings may not apply to patients with a calcified aortic valve without stenosis nor to those with advanced, severe AS.

Disclosures

  • The study received no commercial funding.

  • None of the authors had disclosures.

This is a summary of a preprint research study titled "Impact of Glycemic Control on the Progression of Aortic Stenosis: a Common Data Model Cohort Study," written by researchers from Seoul National University Bundang Hospital in Seongnam, South Korea on Research Square provided to you by Medscape. The study has not yet been peer-reviewed. The full text of the study can be found on researchsquare.com.

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