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Peer-reviewedCC BY 4.0Frontiers in Endocrinology

Glycemic biomarkers and cardiovascular disease in diabetes: a comparative analysis of population-based and clinical cohorts

  • Lihong Zhang1
  • Meng Liu2
  • Yu Zhang1
  • Liyuan Zhao1
  • Yunjiang Liu1
  • Rui Wang1
  • Juan Zhou1
  • Kun Li1
  1. 1Clinical Laboratory, Affiliated Hospital of West Anhui Health Vocational College
  2. 2Department of Clinical Pharmacy, Affiliated Hospital of West Anhui Health Vocational College
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Abstract

Background: Cardiovascular disease (CVD) remains a major complication contributing to morbidity and mortality among individuals with diabetes. Different glycemic biomarkers reflect distinct aspects of glucose metabolism, but their associations with prevalent CVD across different diabetic populations remain incompletely understood. This study aimed to evaluate the associations of fasting blood glucose (FBG), glycated hemoglobin A1c (HbA1c), and triglyceride-glucose index (TyG) with prevalent CVD among adults with diabetes.

Methods: This study included adults with diabetes from two independent cross-sectional cohorts: a population-based cohort derived from the National Health and Nutrition Examination Survey (NHANES) 2005–2020 (n = 3,418) and a Chinese clinical cohort of hospitalized patients with diabetes (n = 765). Multivariable logistic regression models, subgroup analyses, and restricted cubic spline (RCS) analyses were performed to evaluate the associations between glycemic biomarkers and prevalent CVD.

Results: After adjustment for potential confounders, HbA1c was consistently associated with prevalent CVD in both cohorts. In the fully adjusted model, each unit increase in HbA1c was associated with higher odds of prevalent CVD in the population-based cohort (OR = 1.097, 95% CI: 1.002–1.202, P = 0.045) and the clinical cohort (OR = 1.413, 95% CI: 1.280–1.564, P < 0.001). In contrast, FBG and TyG were not significantly associated with prevalent CVD in the fully adjusted models. RCS analyses showed a significant overall association between HbA1c and prevalent CVD without evidence of nonlinearity in the NHANES cohort, whereas a significant nonlinear association was observed in the clinical cohort. TyG also showed a significant nonlinear association with prevalent CVD in the NHANES cohort. Subgroup analyses did not show consistent evidence of effect modification across demographic and clinical characteristics.

Conclusion: Among adults with diabetes, HbA1c showed a consistent positive association with prevalent CVD across population-based and clinical cohorts, whereas the associations of FBG and TyG were less consistent. These findings support the relevance of HbA1c as a measure of long-term glycemic status in relation to prevalent CVD among individuals with diabetes. Further longitudinal studies are warranted to clarify the temporal relationship between HbA1c and cardiovascular outcomes.

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Cite

BibTeXRIS
BibTeX
@article{zhang2026glycemic,
  title = {{Glycemic biomarkers and cardiovascular disease in diabetes: a comparative analysis of population-based and clinical cohorts}},
  author = {Lihong Zhang and Meng Liu and Yu Zhang and Liyuan Zhao and Yunjiang Liu and Rui Wang and Juan Zhou and Kun Li},
  journal = {Frontiers in Endocrinology},
  year = {2026},
  month = oct,
  doi = {10.3389/fendo.2026.1995413},
  url = {https://www.frontiersin.org/articles/10.3389/fendo.2026.1995413/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Glycemic biomarkers and cardiovascular disease in diabetes: a comparative analysis of population-based and clinical cohorts
AU  - Lihong Zhang
AU  - Meng Liu
AU  - Yu Zhang
AU  - Liyuan Zhao
AU  - Yunjiang Liu
AU  - Rui Wang
AU  - Juan Zhou
AU  - Kun Li
PY  - 2026
DA  - 2026/10/14
JO  - Frontiers in Endocrinology
DO  - 10.3389/fendo.2026.1995413
UR  - https://www.frontiersin.org/articles/10.3389/fendo.2026.1995413/full
AB  - Background: Cardiovascular disease (CVD) remains a major complication contributing to morbidity and mortality among individuals with diabetes. Different glycemic biomarkers reflect distinct aspects of glucose metabolism, but their associations with prevalent CVD across different diabetic populations remain incompletely understood. This study aimed to evaluate the associations of fasting blood glucose (FBG), glycated hemoglobin A1c (HbA1c), and triglyceride-glucose index (TyG) with prevalent CVD among adults with diabetes.  Methods: This study included adults with diabetes from two independent cross-sectional cohorts: a population-based cohort derived from the National Health and Nutrition Examination Survey (NHANES) 2005–2020 (n = 3,418) and a Chinese clinical cohort of hospitalized patients with diabetes (n = 765). Multivariable logistic regression models, subgroup analyses, and restricted cubic spline (RCS) analyses were performed to evaluate the associations between glycemic biomarkers and prevalent CVD.  Results: After adjustment for potential confounders, HbA1c was consistently associated with prevalent CVD in both cohorts. In the fully adjusted model, each unit increase in HbA1c was associated with higher odds of prevalent CVD in the population-based cohort (OR = 1.097, 95% CI: 1.002–1.202, P = 0.045) and the clinical cohort (OR = 1.413, 95% CI: 1.280–1.564, P < 0.001). In contrast, FBG and TyG were not significantly associated with prevalent CVD in the fully adjusted models. RCS analyses showed a significant overall association between HbA1c and prevalent CVD without evidence of nonlinearity in the NHANES cohort, whereas a significant nonlinear association was observed in the clinical cohort. TyG also showed a significant nonlinear association with prevalent CVD in the NHANES cohort. Subgroup analyses did not show consistent evidence of effect modification across demographic and clinical characteristics.  Conclusion: Among adults with diabetes, HbA1c showed a consistent positive association with prevalent CVD across population-based and clinical cohorts, whereas the associations of FBG and TyG were less consistent. These findings support the relevance of HbA1c as a measure of long-term glycemic status in relation to prevalent CVD among individuals with diabetes. Further longitudinal studies are warranted to clarify the temporal relationship between HbA1c and cardiovascular outcomes.
SN  - 1664-2392
ER  -