Association between hemoglobin A1c levels and coronary flow reserve in angina with nonobstructive coronary arteries: a retrospective observational study
- 1Department of Internal Medicine, Division of Cardiology, The Jikei University School of Medicine, 3-19-18 Nishi-Shimbashi, Minato-ku, Tokyo Japan
- 2Department of Internal Medicine, Division of Cardiology, The Jikei University School of Medicine, Katsushika Medical Center, Tokyo, Japan
Abstract
Background: Hemoglobin A1c (HbA1c) measures chronic glycemic levels, and its elevation is associated with vascular endothelial dysfunction and microcirculatory impairment, contributing to increased cardiovascular risk. In the assessment of angina with nonobstructive coronary arteries (ANOCA), coronary flow reserve (CFR) reflects vasodilatory capacity of the coronary microvasculature and is associated with adverse cardiovascular events, whereas IMR quantifies microvascular resistance during hyperemia. However, the association between HbA1c levels and invasive microvascular indices in ANOCA remains unclear.
Methods: This study included 104 patients with ANOCA who underwent invasive coronary physiological assessment. CFR and IMR were measured using the thermodilution method. Associations between admission clinical parameters, including demographic characteristics and laboratory variables (particularly HbA1c), and CFR or IMR were examined using univariate and multivariate analyses.
Results: The study population had a mean age of 65.8 ± 13.0 years, 50.0% were male, mean HbA1c was 6.0 ± 0.7%, mean CFR was 4.3 ± 2.4, and mean IMR was 14.2 ± 8.8. Multivariate analysis demonstrated a significant negative association between HbA1c and CFR (β = −0.250, 95% CI: −1.619 to − 0.155, P = 0.018). In contrast, no significant association was observed between HbA1c and IMR.
Conclusions: In patients with ANOCA, higher HbA1c levels were independently associated with reduced CFR but not with IMR. These findings suggest a potential association between chronic glycemic status and coronary vasodilatory function in ANOCA.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12872-026-06449-6.
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BibTeX
@article{shirasaki2026association,
title = {{Association between hemoglobin A1c levels and coronary flow reserve in angina with nonobstructive coronary arteries: a retrospective observational study}},
author = {Keisuke Shirasaki and Takanori Ishida and Kentaro Niiya and Keisuke Kawatsu and Ryosuke Itakura and Kosuke Minai and Takayuki Ogawa and Michifumi Tokuda},
journal = {BMC Cardiovascular Disorders},
year = {2026},
month = aug,
doi = {10.1186/s12872-026-06449-6},
url = {https://doi.org/10.1186/s12872-026-06449-6},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Association between hemoglobin A1c levels and coronary flow reserve in angina with nonobstructive coronary arteries: a retrospective observational study
AU - Keisuke Shirasaki
AU - Takanori Ishida
AU - Kentaro Niiya
AU - Keisuke Kawatsu
AU - Ryosuke Itakura
AU - Kosuke Minai
AU - Takayuki Ogawa
AU - Michifumi Tokuda
PY - 2026
DA - 2026/08/10
JO - BMC Cardiovascular Disorders
DO - 10.1186/s12872-026-06449-6
UR - https://doi.org/10.1186/s12872-026-06449-6
AB - Background: Hemoglobin A1c (HbA1c) measures chronic glycemic levels, and its elevation is associated with vascular endothelial dysfunction and microcirculatory impairment, contributing to increased cardiovascular risk. In the assessment of angina with nonobstructive coronary arteries (ANOCA), coronary flow reserve (CFR) reflects vasodilatory capacity of the coronary microvasculature and is associated with adverse cardiovascular events, whereas IMR quantifies microvascular resistance during hyperemia. However, the association between HbA1c levels and invasive microvascular indices in ANOCA remains unclear. Methods: This study included 104 patients with ANOCA who underwent invasive coronary physiological assessment. CFR and IMR were measured using the thermodilution method. Associations between admission clinical parameters, including demographic characteristics and laboratory variables (particularly HbA1c), and CFR or IMR were examined using univariate and multivariate analyses. Results: The study population had a mean age of 65.8 ± 13.0 years, 50.0% were male, mean HbA1c was 6.0 ± 0.7%, mean CFR was 4.3 ± 2.4, and mean IMR was 14.2 ± 8.8. Multivariate analysis demonstrated a significant negative association between HbA1c and CFR (β = −0.250, 95% CI: −1.619 to − 0.155, P = 0.018). In contrast, no significant association was observed between HbA1c and IMR. Conclusions: In patients with ANOCA, higher HbA1c levels were independently associated with reduced CFR but not with IMR. These findings suggest a potential association between chronic glycemic status and coronary vasodilatory function in ANOCA. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12872-026-06449-6.
SN - 1471-2261
ER -