Interplay of glycated hemoglobin and traditional risk factors for the risk of atherosclerotic cardiovascular disease and all-cause mortality in people without diabetes
Authors' conclusion
HbA1c testing in individuals without diabetes may help identify those at higher risk for ASCVD and mortality, even at the extremes of CVRF burden.
Study context
- Population
- US adults free of diabetes and atherosclerotic cardiovascular disease (ASCVD) with hemoglobin A1c (HbA1c) data; mean age 57.1 (SD 9.1) years, 56.2% women, 21.9% Blackpooled CARDIA, MESA, ARIC, FOS cohorts
- Participants
- 20,360 adults
- Comparison
- HbA1c categories vs 5.0-5.4%, across cardiovascular risk factor (CVRF) burden
- Outcome
- ASCVD and all-cause mortality
- Follow-up
- median 16.7-year follow-up
Methodological detailsmultivariable Cox proportional hazard regression, CARDIA, MESA, ARIC and FOS cohorts
- Multivariable Cox proportional hazard regression
- CARDIA, MESA, ARIC and FOS cohorts
Pooled result
As reported in the abstract
ASCVD
Each group vs HbA1c 5.0-5.4%Hazard ratio (95% CI)
HbA1c 5.5-5.9%
1.17(1.09–1.26)
HbA1c 6.0-6.4%
1.59(1.42–1.78)
- ASCVD events during follow-up
- 3592 (17.6%)
Further pooled results
| Outcome | HR | |
|---|---|---|
| All-cause mortality · median 16.7-year follow-upHbA1c 5.5-5.9%vs HbA1c 5.0-5.4% | 1.14 (95% CI 1.07–1.20) | |
| All-cause mortality · median 16.7-year follow-upHbA1c 6.0-6.4%vs HbA1c 5.0-5.4% | 1.35 (95% CI 1.24–1.47) | |
| All-cause mortality · median 16.7-year follow-upHbA1c < 5.0%vs HbA1c 5.0-5.4% | 1.17 (95% CI 1.07–1.28) | |
| ASCVD, subgroup with 0 CVRFsHbA1c 5.5-5.9%vs HbA1c 5.0-5.4% | 1.26 (CI 1.02–1.55) | |
| ASCVD, subgroup with 0 CVRFsHbA1c 6.0-6.4%vs HbA1c 5.0-5.4% | 1.68 (CI 1.12–2.54) | |
| ASCVD, subgroup with 3 CVRFsHbA1c 5.5-5.9%vs HbA1c 5.0-5.4% | 1.22 (CI 0.88–1.69) | |
| ASCVD, subgroup with 3 CVRFsHbA1c 6.0-6.4%vs HbA1c 5.0-5.4% | 2.00 (CI 1.35–2.97) | |
| 0.20.5125Hazard ratio (log scale) |
| Outcome | P value |
|---|---|
| Mortality with HbA1c ≥ 5.5%, by raceNon-Black vs Black | P for interaction < 0.001 |
- All-cause mortality — Deaths during follow-up
- 6627 (32.6%)
ASCVD, subgroup with 3 CVRFs
- Similar findings for all-cause mortality across CVRF extremes
Mortality with HbA1c ≥ 5.5%, by race
- Increased mortality risk in non-Black individuals; not significant in Black individuals
Original publication
Interplay of glycated hemoglobin and traditional risk factors for the risk of atherosclerotic cardiovascular disease and all-cause mortality in people without diabetes. Cardiovasc Diabetol. Published 24 October 2025. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →