Key result
Elevated HbA1c is linked to ~73% higher incident CVD risk, with stronger excess risk in younger adults.
Why the study?
Optimal control of HbA1c, blood pressure, and cholesterol reduces CVD risk in diabetes, but the age-specific contributions of these factors remain inadequately characterized.
Does the association between baseline HbA1c, blood pressure, and cholesterol (ABC) levels and incident cardiovascular disease vary across different age groups in Chinese adults with diabetes?
Cohort (n=36,583)
Yes
Does the association between baseline HbA1c, blood pressure, and cholesterol (ABC) levels and incident cardiovascular disease vary across different age groups in Chinese adults with diabetes?
In Chinese adults with diabetes, the cardiovascular risks associated with elevated HbA1c, blood pressure, and LDL-C diminish progressively with advancing age, supporting stricter multifactorial risk factor control in younger adults and a more individualized, flexible approach in those aged 75 years or older.
Answers are grounded in this paper and cite their sources.
Stronger ABC-CVD associations in younger diabetic adults; leaves open age-specific targets pending randomized trials.
Optimal control of hemoglobin A1c (HbA1c), blood pressure, and cholesterol (ABC risk factors) is essential for reducing cardiovascular disease (CVD) risk in individuals with diabetes. However, age-specific contributions of these factors remain inadequately characterized. Using data from the China Cardiometabolic Disease and Cancer Cohort study, we assessed the associations between ABC risk factors and incident CVD among Chinese adults with diabetes, stratified by age groups of < 55, 55 to < 65, 65 to < 75, and ≥ 75 years. Cox proportional hazards models and population-attributable fractions (PAFs) were used to quantify the associations between ABC risk factors and incident CVD. During a median follow-up of 10.1 years, 4,707 incident cases of CVD were documented. Higher levels of baseline HbA1c, systolic blood pressure (SBP), and low-density lipoprotein cholesterol (LDL-C) were significantly associated with increased CVD risk. Age modified these associations (P interaction < 0.05), with progressively attenuated hazard ratios (HRs) observed in older age groups. Compared with HbA1c < 7.0%, HbA1c ≥ 9.0% showed stronger CVD associations in adults aged < 55 years (HR = 2.42; 95% confidence interval [CI]) 1.98 − 2.97) than aged ≥ 75 years (HR = 1.50; 95% CI: 1.12 − 2.02), and SBP ≥ 140 mmHg and LDL-C ≥ 4.1 mmol/L were significant only in younger groups. The leading contributor of PAFs for CVD was SBP (28.3%), followed by HbA1c (12.0%) and LDL-C (9.2%), with diminishing impacts across older groups. These results underscore the importance of age-specific management of ABC risk factors in diabetes care, with the benefit of stricter risk factor management in younger adults and the need for a more flexible approach in older populations.
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Yin et al. (2026) conducted a cohort in Diabetes mellitus (n=36,583). Elevated baseline HbA1c (>= 9.0%), systolic blood pressure (>= 140 mmHg), and LDL-C (>= 4.1 mmol/L) across age strata (< 55, 55 to < 65, 65 to < 75, and >= 75 years) vs. Target baseline levels (HbA1c < 7.0%, SBP < 120 mmHg, LDL-C < 2.6 mmol/L) was evaluated on Incident cardiovascular disease (composite of first occurrence of myocardial infarction, stroke, or cardiovascular death) (HR 1.73, 95% CI 1.58-1.89, p=<0.001 for interaction with age). Elevated HbA1c (>=9.0% vs <7.0%), SBP, and LDL-C increased incident CVD risk (overall HbA1c HR 1.73), with stronger associations in adults <55 years (HR 2.42) than >=75 years (HR 1.50; P-interaction<0.001).
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