The U-Shape Relationship Between Glycated Hemoglobin Level and Long-Term All-Cause Mortality Among Patients With
Liwei Liu1,2, Jianfeng Ye3, Ming Ying1
1Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Insights
Glycated hemoglobin (HbA1c) shows a U-shaped association with long-term all-cause death risk in coronary artery disease (CAD) patients. Both very low and high HbA1c levels are linked to increased mortality, highlighting a complex relationship beyond simple risk stratification.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Glycated hemoglobin (HbA1c) is a marker of long-term glycemic control.
- Its prognostic value for all-cause mortality in coronary artery disease (CAD) patients is debated.
- Understanding this relationship is crucial for patient management and outcomes.
Purpose of the Study:
- To investigate the association between baseline HbA1c levels and long-term all-cause mortality in a large cohort of CAD patients.
- To determine if HbA1c is an independent predictor of mortality in this population.
- To explore the shape of the relationship between HbA1c and mortality risk.
Main Methods:
- A cohort of 37,596 CAD patients was analyzed.
- Baseline HbA1c levels were measured at hospital admission.
- Restricted cubic splines and Cox proportional hazards models were used to assess mortality risk over a median 4-year follow-up.
Main Results:
- HbA1c was identified as an independent risk factor for long-term all-cause mortality.
- A U-shaped association was observed: increased mortality risk was linked to HbA1c ≤ 5.7% (aHR=1.13) and HbA1c > 6.7% (aHR=1.32).
- HbA1c levels between 5.7% and 6.7% showed no significant increase in mortality risk compared to the reference group.
Conclusions:
- A significant U-shape relationship exists between HbA1c levels and long-term all-cause mortality in CAD patients.
- Both suboptimal low and high glycemic control, as indicated by HbA1c, are associated with increased mortality risk.
- These findings suggest a need for careful glycemic management in CAD patients, considering both hyperglycemia and hypoglycemia risks.
Abstract:
Background: Although glycated hemoglobin (HbA1c) was considered as a prognostic factor in some subgroup of coronary artery disease (CAD), the specific relationship between HbA1c and the long-term all-cause death remains controversial in patients with CAD. Methods: The study enrolled 37,596 CAD patients and measured HbAlc at admission in Guangdong Provincial People's Hospital. The patients were divided into 4 groups according to HbAlc level (Quartile 1: HbA1c ≤ 5.7%; Quartile 2: 5.7% < HbA1c ≤ 6.1%; Quartile 3: 6.1% < HbA1c ≤ 6.7%; Quartile 4: HbA1c > 6.7%). The study endpoint was all-cause death. The restricted cubic splines and cox proportional hazards models were used to investigate the association between baseline HbAlc levels and long-term all-cause mortality. Results: The median follow-up was 4 years. The cox proportional hazards models revealed that HbAlc is an independent risk factor in the long-term all-cause mortality. We also found an approximate U-shape association between HbA1c and the risk of mortality, including increased risk of mortality when HbA1c ≤ 5.7% and HbA1c > 6.7% [Compared with Quartile 2, Quartile 1 (HbA1c ≤ 5.7), aHR = 1.13, 95% CI:1.01-1.26, P < 0.05; Quartile 3 (6.1% < HbA1c ≤ 6.7%), aHR = 1.04, 95% CI:0.93-1.17, P =0.49; Quartile 4 (HbA1c > 6.7%), aHR = 1.32, 95% CI:1.19-1.47, P < 0.05]. Conclusions: Our study indicated a U-shape relationship between HbA1c and long-term all-cause mortality in CAD patients.
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