{'fraction_non_alphanumeric': 0.04345521992580816, 'fraction_numerical': 0.03709591944886063, 'mean_word_length': 5.2724252491694354, 'pattern_counts': {'":': 0, '<': 1, '<?xml version=': 0, '>': 1, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Association of Baseline HbA1c With Cardiovascular and Renal Outcomes: Analyses From DECLARE-TIMI 58

Objective: Current guidelines recommend prescribing SGLT-2 inhibitors to patients
with type 2 diabetes and established or at high risk for atherosclerotic cardiovascular
disease (ASCVD), irrespective of HbA1c levels. We studied the association of
HbA1c with cardiovascular and renal outcomes and whether the benefit of dapagliflozin
varies by baseline HbA1c.

Methods: In the Dapagliflozin Effect on Cardiovascular Events (DECLARE)-TIMI 58 trial
17,160 patients with type 2 diabetes were randomized to dapagliflozin or
placebo for a median follow up of 4.2 years. Cardiovascular and renal outcomes
by baseline HbA1c in the overall population, and with dapagliflozin vs. placebo
in HbA1c subgroups were studied by Cox regression models.

Results: In the overall population, increasing HbA1c was associated with higher
risk of cardiovascular death or hospitalization for heart failure (CVD/HHF), major
adverse cardiovascular events (MACE; CVD, myocardial infarction, ischemic
stroke) and of the cardiorenal outcome (adjusted HR [95% CI] 1.12 [1.06-1.19], 1.08
[1.04-1.13] and 1.17 [1.11-1.24] per 1% increase respectively). Elevated HbA1c was
associated with an increased risk for MACE and for the cardiorenal outcome significantly
more in patients with multiple risk factors (MRF), vs. patients with established
ASCVD (P-interaction 0.0064 and 0.0093 respectively). Dapagliflozin led to a
decrease in the risk of CVD/HHF, HHF and the cardiorenal outcome vs. placebo
with no heterogeneity by baseline HbA1c (P-interaction >0.05).

Conclusions: High HbA1c levels were associated with greater cardiovascular
and renal risk, particularly in the MRF population, yet the benefits of dapagliflozin
were observed in all subgroups irrespective of baseline HbA1c, including
patients with HbA1c<7%.