title: Contemporary risk estimates of three HbA1cvariables in relation to heart failure following diagnosis of type 2 diabetes.
abstract: We evaluated the association between glycaemic control and the risk of heart failure (HF) in a contemporary cohort of persons followed after diagnosis of type 2 diabetes (T2D).
  
  
  
  Persons with T2D diagnosed between 1998 and 2012 were retrieved from the Clinical Practice Research Data Link in the UK and followed from diagnosis until the event of HF, mortality, drop out from the database due to any other reason, or the end of the study on 1 July 2015. The association between each of three different haemoglobin A1C(HbA1c) metrics and HF was estimated using adjusted proportional hazard models. In the overall cohort (n=94 332), the increased risk for HF per 1% (10 mmol/mol) increase in HbA1cwas 1.15 (95% CI 1.13 to 1.18) for updated mean HbA1c, and 1.06 (1.04 to 1.07) and 1.06 (1.04 to 1.08) for baseline HbA1cand updated latest HbA1c, respectively. When categorised, the hazard risk (HR) for the updated mean HbA1cin relation to HF became higher than for baseline and updated latest HbA1cabove HbA1clevels of 9%, but did not differ at lower HbA1clevels. The updated latest variable showed an increased risk for HbA1c<6% (42 mmol/mol) of 1.16 (1.07 to 1.25), relative category 6-7%, while the HRs for updated mean and baseline HbA1cshowed no such J-shaped pattern.
  
  
  
  Hyperglycaemia is still a risk factor for HF in persons with T2D of similar magnitude as in earlier cohorts. Such a relationship exists for current glycaemic levels, at diagnosis and the overall level but the pattern differs for these variables.
authors.affiliation: AstraZeneca R&D, Mölndal, Sweden.|Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Stanko
authors.initials: S
authors.lastname: Skrtic
authors.affiliation: AstraZeneca R&D, Mölndal, Sweden.
authors.forename: Claudia
authors.initials: C
authors.lastname: Cabrera
authors.affiliation: AstraZeneca R&D, Mölndal, Sweden.|Mathematical Sciences, Chalmers University of Technology, Gothenburg, Sweden.
authors.forename: Marita
authors.initials: M
authors.lastname: Olsson
authors.affiliation: AstraZeneca R&D, Mölndal, Sweden.
authors.forename: Volker
authors.initials: V
authors.lastname: Schnecke
authors.affiliation: Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.|Department of Medicine, NU-Hospital Group, Uddevalla Hospital, Sweden.
authors.forename: Marcus
authors.initials: M
authors.lastname: Lind
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D057286:Electronic Health Records; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human