Association between waist-to-height-haemoglobin A1c index and subclinical myocardial injury in individuals with and without hypertension

AIMS: Recently, a novel metabolic indicator, the Waist-to-Height-Haemoglobin A1c (WHH) index, has been shown to be associated with diabetes risk. This study investigated the association of WHH with the Cardiac Infarction/Injury Score (CIIS) and the risk of subclinical myocardial injury (SC-MI), stratified by hypertension status. METHODS: We conducted a cross-sectional analysis of 5,597 adults aged ≥40 years from the Third National Health and Nutrition Examination Survey who were free of CVD. The WHH index was calculated as waist circumference/height × HbA1c. SC-MI was defined as a CIIS ≥10 on a 12-lead electrocardiogram. Using weighted generalised linear and logistic regression models, we examined the associations of WHH with CIIS and SC-MI. Nonlinear relationships were assessed using restricted cubic spline (RCS) models. RCS analysis confirmed a linear relationship between WHH and SC-MI risk among individuals with hypertension. CONCLUSIONS: These findings demonstrate a significant association between the WHH index and subclinical myocardial injury, particularly among adults with hypertension.