Association between the hemoglobin A1c/High-density lipoprotein cholesterol ratio and stroke incidence: a prospective nationwide cohort study in China
Abstract Background Stroke has emerged as an escalating public health challenge among middle-aged and older individuals in China, closely linked to glycolipid metabolic abnormalities. The Hemoglobin A1c/High-Density Lipoprotein Cholesterol (HbA1c/HDL-C) ratio, an integrated marker of glycolipid home...
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BMC
2025-01-01
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| Series: | Lipids in Health and Disease |
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| Online Access: | https://doi.org/10.1186/s12944-025-02438-4 |
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| author | Chaojuan Huang Hongtao You Yuyang Zhang Ligang Fan Xingliang Feng Naiyuan Shao |
| author_facet | Chaojuan Huang Hongtao You Yuyang Zhang Ligang Fan Xingliang Feng Naiyuan Shao |
| author_sort | Chaojuan Huang |
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| description | Abstract Background Stroke has emerged as an escalating public health challenge among middle-aged and older individuals in China, closely linked to glycolipid metabolic abnormalities. The Hemoglobin A1c/High-Density Lipoprotein Cholesterol (HbA1c/HDL-C) ratio, an integrated marker of glycolipid homeostasis, may serve as a novel predictor of stroke risk. Methods Our investigation utilized data from the China Health and Retirement Longitudinal Study cohort (2011–2018). Stroke cases were identified based on self-reported, physician-confirmed diagnoses. Logistic regression models were established to determine the correlation between HbA1c/HDL-C and stroke prevalence (2011) as well as between cumulative mean HbA1c/HDL-C (2011–2015) and new stroke incidence (2015–2018). Additionally, smoothed curve fitting, subgroup analyses, and interaction tests were conducted to ensure the robustness of the findings. Results In the cross-sectional analysis, 8,502 participants were enrolled, of whom 189 had a history of stroke. Our findings revealed a significant positive linear relationship between HbA1c/HDL-C and stroke prevalence after adjusting for covariates (OR: 1.26, 95% CI: 1.09–1.45). When HbA1c/HDL-C was categorized into tertiles, only the highest tertile (T3) showed a significant correlation with stroke prevalence compared to the lowest tertile (T1) (OR:1.71, 95% CI: 1.05–2.77). In the longitudinal analysis of 5,165 participants, 336 cases of new-onset stroke were identified over a follow-up period of 7 years. Adjusting for confounders, individuals with higher cumulative mean HbA1c/HDL-C exhibited an increased likelihood of new stroke incidence (OR: 1.14, 95% CI: 1.01–1.29). Using the T1 of cumulative mean HbA1c/HDL-C as a reference, the fully adjusted OR for stroke was 1.65 (95% CI: 1.21–2.24) in T2 and 1.54 (95% CI: 1.08–2.19) in T3. The predictive value of the HbA1c/HDL-C in stroke risk assessment have been significantly improved compared to the traditional HDL-C and HbA1c. Consistent associations were observed across most stratified subgroups. Conclusions Elevated baseline and cumulative mean HbA1c/HDL-C levels are significantly associated with an increased risk of stroke among middle-aged and older individuals in China, underscoring the potential of HbA1c/HDL-C as a clinical marker for long-term stroke risk assessment and prevention strategies. |
| format | Article |
| id | doaj-art-27c01600278e4dbca17f8d50274cc667 |
| institution | Kabale University |
| issn | 1476-511X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
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| series | Lipids in Health and Disease |
| spelling | doaj-art-27c01600278e4dbca17f8d50274cc6672025-01-26T12:50:32ZengBMCLipids in Health and Disease1476-511X2025-01-0124111610.1186/s12944-025-02438-4Association between the hemoglobin A1c/High-density lipoprotein cholesterol ratio and stroke incidence: a prospective nationwide cohort study in ChinaChaojuan Huang0Hongtao You1Yuyang Zhang2Ligang Fan3Xingliang Feng4Naiyuan Shao5Department of Neurology, The First Affiliated Hospital of Anhui Medical UniversityDepartment of Neurosurgery, The Third Affiliated Hospital of Soochow UniversityDepartment of Urology, The First Affiliated Hospital of Anhui Medical UniversityDepartment of Neurosurgery, The Third Affiliated Hospital of Soochow UniversityDepartment of Urology, The Third Affiliated Hospital of Soochow UniversityDepartment of Neurosurgery, The Third Affiliated Hospital of Soochow UniversityAbstract Background Stroke has emerged as an escalating public health challenge among middle-aged and older individuals in China, closely linked to glycolipid metabolic abnormalities. The Hemoglobin A1c/High-Density Lipoprotein Cholesterol (HbA1c/HDL-C) ratio, an integrated marker of glycolipid homeostasis, may serve as a novel predictor of stroke risk. Methods Our investigation utilized data from the China Health and Retirement Longitudinal Study cohort (2011–2018). Stroke cases were identified based on self-reported, physician-confirmed diagnoses. Logistic regression models were established to determine the correlation between HbA1c/HDL-C and stroke prevalence (2011) as well as between cumulative mean HbA1c/HDL-C (2011–2015) and new stroke incidence (2015–2018). Additionally, smoothed curve fitting, subgroup analyses, and interaction tests were conducted to ensure the robustness of the findings. Results In the cross-sectional analysis, 8,502 participants were enrolled, of whom 189 had a history of stroke. Our findings revealed a significant positive linear relationship between HbA1c/HDL-C and stroke prevalence after adjusting for covariates (OR: 1.26, 95% CI: 1.09–1.45). When HbA1c/HDL-C was categorized into tertiles, only the highest tertile (T3) showed a significant correlation with stroke prevalence compared to the lowest tertile (T1) (OR:1.71, 95% CI: 1.05–2.77). In the longitudinal analysis of 5,165 participants, 336 cases of new-onset stroke were identified over a follow-up period of 7 years. Adjusting for confounders, individuals with higher cumulative mean HbA1c/HDL-C exhibited an increased likelihood of new stroke incidence (OR: 1.14, 95% CI: 1.01–1.29). Using the T1 of cumulative mean HbA1c/HDL-C as a reference, the fully adjusted OR for stroke was 1.65 (95% CI: 1.21–2.24) in T2 and 1.54 (95% CI: 1.08–2.19) in T3. The predictive value of the HbA1c/HDL-C in stroke risk assessment have been significantly improved compared to the traditional HDL-C and HbA1c. Consistent associations were observed across most stratified subgroups. Conclusions Elevated baseline and cumulative mean HbA1c/HDL-C levels are significantly associated with an increased risk of stroke among middle-aged and older individuals in China, underscoring the potential of HbA1c/HDL-C as a clinical marker for long-term stroke risk assessment and prevention strategies.https://doi.org/10.1186/s12944-025-02438-4Hemoglobin A1cHigh-Density Lipoprotein CholesterolHbA1c/HDL-C RatioStrokeCHARLS |
| spellingShingle | Chaojuan Huang Hongtao You Yuyang Zhang Ligang Fan Xingliang Feng Naiyuan Shao Association between the hemoglobin A1c/High-density lipoprotein cholesterol ratio and stroke incidence: a prospective nationwide cohort study in China Lipids in Health and Disease Hemoglobin A1c High-Density Lipoprotein Cholesterol HbA1c/HDL-C Ratio Stroke CHARLS |
| title | Association between the hemoglobin A1c/High-density lipoprotein cholesterol ratio and stroke incidence: a prospective nationwide cohort study in China |
| title_full | Association between the hemoglobin A1c/High-density lipoprotein cholesterol ratio and stroke incidence: a prospective nationwide cohort study in China |
| title_fullStr | Association between the hemoglobin A1c/High-density lipoprotein cholesterol ratio and stroke incidence: a prospective nationwide cohort study in China |
| title_full_unstemmed | Association between the hemoglobin A1c/High-density lipoprotein cholesterol ratio and stroke incidence: a prospective nationwide cohort study in China |
| title_short | Association between the hemoglobin A1c/High-density lipoprotein cholesterol ratio and stroke incidence: a prospective nationwide cohort study in China |
| title_sort | association between the hemoglobin a1c high density lipoprotein cholesterol ratio and stroke incidence a prospective nationwide cohort study in china |
| topic | Hemoglobin A1c High-Density Lipoprotein Cholesterol HbA1c/HDL-C Ratio Stroke CHARLS |
| url | https://doi.org/10.1186/s12944-025-02438-4 |
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