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Glycemic biomarkers and cardiovascular disease in diabetes: a comparative analysis of population-based and clinical cohorts

Year: 2026

Type: article

Abstract: Background: Cardiovascular disease (CVD) remains a major complication contributing to morbidity and mortality among individuals with diabetes. Different glycemic biomarkers reflect distinct aspects of glucose metabolism, but their associations with prevalent CVD across different diabetic populations remain incompletely understood. This study aimed to evaluate the associations of fasting blood glucose (FBG), glycated hemoglobin A1c (HbA1c), and triglyceride-glucose index (TyG) with prevalent CVD among adults with diabetes. Methods: This study included adults with diabetes from two independent cross-sectional cohorts: a population-based cohort derived from the National Health and Nutrition Examination Survey (NHANES) 2005-2020 (n = 3,418) and a Chinese clinical cohort of hospitalized patients with diabetes (n = 765). Multivariable logistic regression models, subgroup analyses, and restricted cubic spline (RCS) analyses were performed to evaluate the associations between glycemic biomarkers and prevalent CVD. Results: < 0.001). In contrast, FBG and TyG were not significantly associated with prevalent CVD in the fully adjusted models. RCS analyses showed a significant overall association between HbA1c and prevalent CVD without evidence of nonlinearity in the NHANES cohort, whereas a significant nonlinear association was observed in the clinical cohort. TyG also showed a significant nonlinear association with prevalent CVD in the NHANES cohort. Subgroup analyses did not show consistent evidence of effect modification across demographic and clinical characteristics. Conclusion: Among adults with diabetes, HbA1c showed a consistent positive association with prevalent CVD across population-based and clinical cohorts, whereas the associations of FBG and TyG were less consistent. These findings support the relevance of HbA1c as a measure of long-term glycemic status in relation to prevalent CVD among individuals with diabetes. Further longitudinal studies are warranted to clarify the temporal relationship between HbA1c and cardiovascular outcomes.

Source: Frontiers in Endocrinology

DOI: 10.3389/fendo.2026.1995413