U-shaped association between HbA1c and all-cause mortality in CVD patients with diabetes
Abstract In this analysis, the association of baseline glycated hemoglobin (HbA1c) levels with all-cause mortality in cardiovascular disease (CVD) patients with diabetes was investigated using data from NHANES 1999–2014. Under examination were 845 CVD patients who had diabetes and were followed for...
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Nature Portfolio
2024-11-01
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| Online Access: | https://doi.org/10.1038/s41598-024-80116-8 |
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| author | Jianhong Yu Haodong Hua Minggang Yin |
| author_facet | Jianhong Yu Haodong Hua Minggang Yin |
| author_sort | Jianhong Yu |
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| description | Abstract In this analysis, the association of baseline glycated hemoglobin (HbA1c) levels with all-cause mortality in cardiovascular disease (CVD) patients with diabetes was investigated using data from NHANES 1999–2014. Under examination were 845 CVD patients who had diabetes and were followed for a median follow-up of 7.3 years, and an all-cause mortality rate of 22.60% was observed. To examine the association between HbA1c and mortality, multivariable Cox proportional hazard models using spline models determined the non-linear association. HbA1c as a continuous variable was not associated with mortality. However, a significant association was observed when HbA1c was classified according to quartiles. Particularly, after adjustment for potential confounders, in comparison to participants with HbA1c levels below 6.2%, patients with HbA1c levels of 6.2–6.8% and 6.9–7.6% had lower risks of all-cause mortality (hazard ratio: 0.49, 95% CI: 0.30–0.80 and hazard ratio: 0.64, 95% CI: 0.39–1.03, respectively). Using restricted cubic splines, further testing confirmed the lack of a linear association and instead suggested a U-shaped relationship between HbA1c and mortality, with an optimal HbA1c target value of 6.9%. A 1-unit increase in HbA1c with HbA1c less than or equal to 6.9% was predictive of a 55% reduction in all-cause mortality compared to HbA1c levels above 6.9%, which exhibited an elevation in risk. All told, these data suggest that the relationship between HbA1c and all-cause mortality in CVD patients with diabetes is non-linear and U-shaped, and therefore may suggest that individualization of glycemic control may be beneficial for this patient population. |
| format | Article |
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| spelling | doaj-art-1392b85d028d438c8fbe2e1554a6c6e12025-08-20T02:33:05ZengNature PortfolioScientific Reports2045-23222024-11-011411910.1038/s41598-024-80116-8U-shaped association between HbA1c and all-cause mortality in CVD patients with diabetesJianhong Yu0Haodong Hua1Minggang Yin2Department of Clinical Laboratory, Zigong First People’s HospitalDepartment of Clinical Laboratory, Zigong First People’s HospitalDepartment of Clinical Laboratory, Zigong First People’s HospitalAbstract In this analysis, the association of baseline glycated hemoglobin (HbA1c) levels with all-cause mortality in cardiovascular disease (CVD) patients with diabetes was investigated using data from NHANES 1999–2014. Under examination were 845 CVD patients who had diabetes and were followed for a median follow-up of 7.3 years, and an all-cause mortality rate of 22.60% was observed. To examine the association between HbA1c and mortality, multivariable Cox proportional hazard models using spline models determined the non-linear association. HbA1c as a continuous variable was not associated with mortality. However, a significant association was observed when HbA1c was classified according to quartiles. Particularly, after adjustment for potential confounders, in comparison to participants with HbA1c levels below 6.2%, patients with HbA1c levels of 6.2–6.8% and 6.9–7.6% had lower risks of all-cause mortality (hazard ratio: 0.49, 95% CI: 0.30–0.80 and hazard ratio: 0.64, 95% CI: 0.39–1.03, respectively). Using restricted cubic splines, further testing confirmed the lack of a linear association and instead suggested a U-shaped relationship between HbA1c and mortality, with an optimal HbA1c target value of 6.9%. A 1-unit increase in HbA1c with HbA1c less than or equal to 6.9% was predictive of a 55% reduction in all-cause mortality compared to HbA1c levels above 6.9%, which exhibited an elevation in risk. All told, these data suggest that the relationship between HbA1c and all-cause mortality in CVD patients with diabetes is non-linear and U-shaped, and therefore may suggest that individualization of glycemic control may be beneficial for this patient population.https://doi.org/10.1038/s41598-024-80116-8 |
| spellingShingle | Jianhong Yu Haodong Hua Minggang Yin U-shaped association between HbA1c and all-cause mortality in CVD patients with diabetes Scientific Reports |
| title | U-shaped association between HbA1c and all-cause mortality in CVD patients with diabetes |
| title_full | U-shaped association between HbA1c and all-cause mortality in CVD patients with diabetes |
| title_fullStr | U-shaped association between HbA1c and all-cause mortality in CVD patients with diabetes |
| title_full_unstemmed | U-shaped association between HbA1c and all-cause mortality in CVD patients with diabetes |
| title_short | U-shaped association between HbA1c and all-cause mortality in CVD patients with diabetes |
| title_sort | u shaped association between hba1c and all cause mortality in cvd patients with diabetes |
| url | https://doi.org/10.1038/s41598-024-80116-8 |
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