Hemoglobin A1c is more predictive of type 1 myocardial infarction than low-density lipoprotein or body mass index

Dyslipidemia and diabetes are traditional risk factors for myocardial infarction (MI), with obesity and prediabetes now recognized as non-traditional ones. Few studies have investigated the prevalence of these diseases at the time of admission for MI. To clarify their relative importance, we collected hemoglobin A1c (HbA1c), body mass index (BMI), and lipid profiles at the time of admission for patients with type 1 MI over 10 years at a major academic center.

This was a single-center retrospective cohort study. We examined 570 patients admitted for type 1 MI over 10 years, collected their HbA1c, BMI, and lipid profiles at or near admission, and compared them to an age- and sex-matched control group of admitted patients. After adjusting for potential confounders, only HbA1c was associated with increased odds of type 1 MI (odds ratio 1.12). When compared to patients with clinically normal HbA1c (<5.7), patients with HbA1c ≥ 6.5 had 160% higher odds of MI, and patients with prediabetic range HbA1c (5.7-6.4) had 58% higher odds of MI. The interaction between sex and these metabolic variables was not statistically significant. Younger patients had a stronger association between the risk of MI and both LDL and BMI, compared to older patients. There was no statistically significant change in average HbA1c, BMI, or LDL across the 10-year timespan.

Admission HbA1c level has a stronger association with type 1 myocardial infarction than admission LDL or BMI, even among patients with levels in the prediabetic range.