Huang Chaojuan, You Hongtao, Zhang Yuyang, Fan Ligang, Feng Xingliang, Shao Naiyuan
Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, China.
Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, 213000, China.
Lipids Health Dis. 2025 Jan 25;24(1):25. doi: 10.1186/s12944-025-02438-4.
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.
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.
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.
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.
在中国，中风已成为中老年人群中日益严峻的公共卫生挑战，与糖脂代谢异常密切相关。糖化血红蛋白/高密度脂蛋白胆固醇（HbA1c/HDL-C）比值作为糖脂稳态的综合标志物，可能是中风风险的新型预测指标。
我们的研究利用了中国健康与养老追踪调查队列（2011 - 2018年）的数据。根据自我报告且经医生确认的诊断来确定中风病例。建立逻辑回归模型以确定HbA1c/HDL-C与中风患病率（2011年）之间以及累积平均HbA1c/HDL-C（2011 - 2015年）与新中风发病率（2015 - 2018年）之间的相关性。此外，进行了平滑曲线拟合、亚组分析和交互作用检验以确保研究结果的稳健性。
在横断面分析中，纳入了8502名参与者，其中189人有中风病史。我们的研究结果显示，在调整协变量后，HbA1c/HDL-C与中风患病率之间存在显著的正线性关系（比值比：1.26，95%置信区间：1.09 - 1.45）。当将HbA1c/HDL-C分为三个三分位数时，与最低三分位数（T1）相比，只有最高三分位数（T3）与中风患病率显著相关（比值比：1.71，95%置信区间：1.05 - 2.77）。在对5165名参与者的纵向分析中，在7年的随访期内确定了336例新发中风病例。在调整混杂因素后，累积平均HbA1c/HDL-C较高的个体发生新中风的可能性增加（比值比：1.14，95%置信区间：1.01 - 1.29）。以累积平均HbA1c/HDL-C的T1为参照，在T2中中风的完全调整后比值比为1.65（95%置信区间：1.21 - 2.24），在T3中为1.54（95%置信区间：1.08 - 2.19）。与传统的HDL-C和HbA1c相比，HbA1c/HDL-C在中风风险评估中的预测价值有显著提高。在大多数分层亚组中观察到一致的关联。
在中国中老年人群中，基线和累积平均HbA1c/HDL-C水平升高与中风风险增加显著相关，这突出了HbA1c/HDL-C作为长期中风风险评估和预防策略的临床标志物的潜力。
