HbA1c identifies people at risk of subclinical atherosclerosis

Routine use of glycated haemoglobin (HbA1c) helps pinpoint asymptomatic individuals who are at greater risk of subclinical atherosclerosis (SA) on top of traditional cardiovascular risk factors (CVRFs), according to a study.

The investigators assessed a cohort of 3,973 middle-aged individuals from the Progression of Early Subclinical Atherosclerosis study, with no history of cardiovascular disease and with HbA1c in the nondiabetic range, for the presence and extent of SA using two-dimensional vascular ultrasound and noncontrast cardiac computed tomography.

After adjustments for established CVRFs, HbA1c correlated with the multiterritorial extent of SA (odds ratio [OR], 1.05, 1.27, 1.27, 1.36, 1.80, 1.87, and 2.47 for HbA1c 4.9–5.0 percent, 5.1–5.2 percent, 5.3–5.4 percent, 5.5–5.6 percent, 5.7–5.8 percent, 5.9–6.0 percent, and 6.1–6.4 percent, respectively; reference HbA1c ≤4.8 percent; p<0.001).

The association was significant across prediabetes groups and even below the prediabetes cutoff (HbA1c 5.5–5.6 percent OR, 1.36, 95 percent confidence interval, 1.03–1.80; p=0.033).

In addition, high HbA1c correlated with a higher risk of SA in low-risk individuals (p<0.001) but not in those with moderate risk (p=0.335).

In relative risk estimations using Systematic Coronary Risk Estimation or atherosclerotic cardiovascular disease predictors, the inclusion of HbA1c was found to modify the risk of multiterritorial SA in most risk categories.

“Lifestyle interventions and novel antidiabetic medications might be considered to reduce both HbA1c levels and SA in individuals without diabetes,” the investigators said.