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Nonlinear association of HbA1c/HDL-C ratio with heart failure in adults: a large cross-sectional study

Miao Li1, Mei Hu2, Xujue Ma3

  • 1Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Frontiers in Cardiovascular Medicine
|June 19, 2026
PubMed

Insights

The HbA1c/HDL-C ratio is linked to an increased risk of heart failure (HF). This novel biomarker shows a nonlinear association, with higher risk observed below a specific threshold, suggesting its utility in HF prediction.

Area of Science:

  • Cardiology
  • Metabolic Syndrome
  • Biomarker Discovery

Background:

  • Heart failure (HF) is a major global health concern.
  • The HbA1c/HDL-C ratio, combining glycemic control and lipid metabolism, is a novel biomarker.
  • Its association with HF risk requires further investigation.

Purpose of the Study:

  • To investigate the relationship between the HbA1c/HDL-C ratio and heart failure (HF).
  • To explore the predictive value of this ratio for HF risk.

Main Methods:

  • Utilized data from NHANES (1999-2018) and a clinical cardiology sample.
  • Employed multivariate logistic regression, RCS regression, and ROC curve analysis.
  • Examined the association between HbA1c/HDL-C ratio and HF prevalence.

Main Results:

  • A positive association was found between the HbA1c/HDL-C ratio and HF risk in both datasets.
  • A nonlinear relationship was observed, with significantly increased risk below an HbA1c/HDL-C ratio of 6.21.
  • The HbA1c/HDL-C ratio demonstrated superior predictive power for HF compared to HbA1c or HDL-C alone.

Conclusions:

  • The HbA1c/HDL-C ratio is nonlinearly associated with heart failure risk.
  • An HbA1c/HDL-C ratio below 6.21 indicates a significantly elevated risk.
  • This ratio serves as a valuable composite biomarker for predicting HF.
Abstract

Keywords:
NHANEShbA1c/HDL-C ratioheart failureinpatientsnonlinear associationrestricted cubic spline

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