Glycated Hemoglobin and Risk of Arterial Stiffness in Chinese Han Population: A Longitudinal Study

Abstract Background: Glycated hemoglobin (HbA1c) is related to the risk and the progression of arterial stiffness, and such association can be found between fasting blood glucose (FBG), postprandial blood glucose (PBG), triglyceride-glucose index (TyG Index) and arterial stiffness. But the relationship in different studies is inconsistent, such longitudinal studies were sparse, and the comparison in effects of these four parameters on arterial stiffness was less conducted. We aimed to explore the longitudinal relationship between HbA1c and arterial stiffness adjusting for confounding factors in Chinese Han population and compare the risk effect of HbA1c, FBG, PBG, and TyG index on arterial stiffness.Methods: Data were collected from 2011-2012 and 2018-2019 survey in the Beijing Health Management Cohort（BHMC）study and 3048 participants were enrolled. Cox proportional hazard models were fitted to investigate the association between HbA1c, FBG, PBG, TyG index and arterial stiffness after adjusting for multiple general confounding factors. Results: Among the 3048 subjects, 591 were diagnosed as arterial stiffness during the follow-up. The adjusted HRs (95% confidence interval (CI)) for arterial stiffness compared with the lowest quartile HbA1c group were 1.22 (95% CI: 0.93-1.62), 1.52 (95% CI: 1.17-1.98) and 2.05 (95% CI: 1.59-2.63) of the three higher quartile groups respectively, which were higher than those of FBG, PBG and TyG index. Each 1% increasing of HbA1c indicated a 39% (HR: 1.39, 95% CI: 1.25-1.53) higher risk of arterial stiffness. Sensitivity analysis showed the consistent results treating the parameters as continuous variable. No significant association was found between TyG index and the risk of arterial stiffness, neither in continuous nor in polytomous form. The restricted cubic spline showed nonlinear association between HbA1c, PBG and arterial stiffness, but such association was not found for FBG and TyG index.Conclusion: HbA1c can be treated as an important risk factor of arterial stiffness. Individuals with higher level of HbA1c had higher risk of arterial stiffness compared with PBG, FBG and TyG index.