Relationship between hemoglobin A1c and serum troponin in patients with diabetes and cardiovascular events
Stjepan Šimić1, Tomo Svaguša1,2, Ingrid Prkačin1,3
11School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia.
Insights
Elevated hemoglobin A1c (HbA1c) is linked to higher troponin levels in diabetic patients with cardiovascular events. This indicates HbA1c is a predictor of adverse outcomes, including mortality, in these individuals.
Area of Science:
- Cardiology
- Endocrinology
- Biochemistry
Background:
- Diabetes mellitus significantly increases cardiovascular disease risk.
- Troponins, while key for acute coronary syndrome diagnosis, also aid risk assessment in various conditions.
- Understanding the link between glycemic control and cardiac biomarkers is crucial for patient management.
Purpose of the Study:
- To investigate the relationship between hemoglobin A1c (HbA1c) and serum troponin levels.
- To explore the predictive value of HbA1c in diabetic patients experiencing cardiovascular events.
Main Methods:
- Review of existing literature on HbA1c and cardiac troponins (T, I, C).
- HbA1c identified as the primary indicator for glucose control and micro/macrovascular complication risk.
- Cardiac troponins T and I specified as myocardial injury markers.
Main Results:
- A causal relationship was established between HbA1c levels and serum troponin concentrations.
- HbA1c demonstrated a positive predictive role in the incidence, mortality, and morbidity of cardiovascular events.
- Conditions causing troponin elevation, such as acute coronary syndrome and stroke, were associated with higher HbA1c.
Conclusions:
- Chronic hyperglycemia impairs glomerular filtration, reducing troponin elimination.
- Cardiac microcirculation damage due to hyperglycemia contributes to myocardial ischemia and troponin elevation.
- The correlation between HbA1c and troponin has prognostic significance for mortality in diabetic patients.
Objectives:
Diabetes mellitus is a group of metabolic disorders associated with high risk for cardiovascular disease. Although troponins are primarily clinically used for the diagnosis of acute coronary syndrome, they are also used in risk assessment in patients with acute coronary syndrome as well as in a number of other conditions. The aim of this review was to investigate the relationship between hemoglobin A1c and serum troponin in patients with diabetes and cardiovascular events.
Methods:
Hemoglobin A1c has been chosen as the best clinical indicator of glucose control and risk of micro and macrovascular complications. We investigated cardiac troponins as a group of markers of muscle injury which includes troponin T, troponin I and troponin C. Troponin T and I are specific for myocardial injury, compared to C which is specific for skeletal muscle.
Results:
In this review, we showed that there was a causal relation between hemoglobin A1c levels and serum troponin concentrations. Hemoglobin A1c has shown to be a positive predictive factor of incidence, mortality and morbidity of conditions such as acute coronary syndrome, arrhythmias, stroke, pulmonary embolism and other conditions that causes troponin elevation by its release in circulation.
Conclusions:
Chronic hyperglycemia decreases glomerular filtration and consequently decreases troponin elimination and also by affecting the heart microcirculation it leads to microvascular damage and consequently to ischemia which contribute to troponin concentration elevation. Furthermore, correlation between hemoglobin A1c and troponin concentration manifests in their prognostic value for mortality.
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