Associations of high-normal blood pressure and impaired fasting glucose with atrial fibrillation

Association and pathways of baseline and longitudinal hemoglobin A1c with the risk of incident stroke: A nationwide prospective cohort study

AIMS

To investigate the association of baseline and long-term mean hemoglobin A1c (HbA1c) with the risk of stroke.

METHODS

A total of 11,220 participants aged over 45 years and without stroke at baseline were enrolled from the China Health and Retirement Longitudinal Study. Mean HbA1c was calculated as the mean of HbA1c at all previous visits before stroke occurred or the end of follow-up. Multivariable-adjusted Cox regressions and Bayesian network were used for the analysis.

RESULTS

During a median follow-up of 7.50 years, a total of 626 cases of stroke occurred. The risk of stroke increased with quintiles of baseline and mean HbA1c, the hazard ratio (HR) in Q5 versus Q1 was 1.30 (95 % confidence interval [CI],1.03-1.64) and 1.79 (95 % CI, 1.38-2.34), respectively. Per 1 unit increase in baseline and mean HbA1c was associated with 10 % (HR, 1.10; 95 % CI, 1.02-1.18) an 12 % (HR, 1.12; 95 % CI, 1.05-1.19) higher risk of stroke. Bayesian network analysis showed that the pathway from HbA1c to stroke was through hypertension, dyslipidemia, obesity, and inflammation.

CONCLUSIONS

Elevated levels of both baseline and long-term HbA1c were associated with increased risk of stroke, and hypertension and obesity played an important role in the pathway.

Associations of combined polygenic risk score and glycemic status with atrial fibrillation, coronary artery disease and ischemic stroke

BACKGROUND

It is unknown whether high hemoglobin A1c (HbA1c) is associated with increases in the risk of cardiovascular disease among individuals with elevated genetic susceptibility. We aimed to investigate the association between HbA1c and atrial fibrillation (AF), coronary artery disease (CAD), and ischemic stroke according to the polygenic risk score (PRS).

METHODS

The UK Biobank cohort included 502,442 participants aged 40-70 years who were recruited from 22 assessment centers across the United Kingdom from 2006 to 2010. This study included 305,605 unrelated individuals with available PRS and assessed new-onset AF, CAD, and ischemic stroke. The participants were divided into tertiles based on the validated PRS for each outcome. Within each PRS tertiles, the risks of incident events associated with HbA1c levels were investigated and compared with HbA1c < 5.7% and low PRS. Data were analyzed from November 2022 to May 2023.

RESULTS

Of 305,605 individuals, 161,605 (52.9%) were female, and the mean (SD) age was 56.6 (8.1) years. During a median follow-up of 11.9 (interquartile range 11.1-12.6) years, the incidences of AF, CAD, and ischemic stroke were 4.6, 2.9 and 1.1 per 100 person-years, respectively. Compared to individuals with HbA1c < 5.7% and low PRS, individuals with HbA1c ≥ 6.5% and high PRS had a 2.67-times higher risk for AF (hazard ratio [HR], 2.67; 95% confidence interval (CI), 2.43-2.94), 5.71-times higher risk for CAD (HR, 5.71; 95% CI, 5.14-6.33) and 2.94-times higher risk for ischemic stroke (HR, 2.94; 95% CI, 2.47-3.50). In the restricted cubic spline models, while a U-shaped trend was observed between HbA1c and the risk of AF, dose-dependent increases were observed between HbA1c and the risk of CAD and ischemic stroke regardless PRS tertile.

CONCLUSIONS

Our results suggest that the nature of the dose-dependent relationship between HbA1c levels and cardiovascular disease in individuals with different PRS is outcome-specific. This adds to the evidence that PRS may play a role together with glycemic status in the development of cardiovascular disease.