Impact of Glycemic Control on the Progression of Aortic Stenosis: a Common Data Model Cohort Study

Abstract Background: The presence of diabetes mellitus (DM) is a well-established risk factor for the progression of degenerative aortic stenosis (AS). However, no study has investigated the impact of glycemic control on the rate of AS progression. We aimed to assess the association between the degree of glycemic control and the AS progression, using an electronic health record-based common data model (CDM).Methods: We identified 1420 patients with mild to moderate AS (defined as an aortic valve [AV] maximal velocity [Vpeak] of 2.0–4.0 m/sec) at baseline, and follow-up echocardiography performed at an interval of ≥6 months. Patients were divided into 3 groups: no DM (n=1037), well-controlled DM (mean glycated hemoglobin [HbA1c] <7.0% during the study period; n=186), and poorly controlled DM (mean HbA1c ≥7.0% during the study period; n=143). The primary outcome was the AS progression rate, calculated as the annualized change in the Vpeak (△Vpeak/year).Results: During follow-up (median 18.4 months), the total study population showed a gradual progression in AS severity. The mean HbA1c level during follow-up was proportionally associated with a higher AS progression rate (β=0.024; 95% confidence interval [CI] 0.006–0.043; p=0.011); a 1% increase in HbA1c was associated with a 27% higher risk of accelerated AS progression, and HbA1c ≥7.0% was significantly associated with an accelerated AS progression (adjusted odds ratio=1.524; 95% CI 1.010–2.285; p=0.043). This association between the degree of glycemic control and AS progression rate was observed regardless of the baseline AS severity.Conclusion: In patients with mild to moderate AS, the degree of glycemic control was significantly associated with AS progression. More intensive glycemic control might be beneficial for the prevention of AS progression in patients with DM and mild to moderate AS.