ArticleLipids in health and disease2025
Association between the hemoglobin A1c/High-density lipoprotein cholesterol ratio and stroke incidence: a prospective nationwide cohort study in China.
Article in Lipids in health and disease, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Effects ofNutrients · 2025Pooled it
- Associations between the CHG index, its modified versions and incident stroke in patients with early-stage CKM syndrome: a nationwide cohort study.European journal of medical research · 2026Article
- The association between HbA1c/HDL-C ratio and cardiometabolic multimorbidity among middle-aged and older adults: data from two national prospective cohorts in the United Kingdom and United States.Frontiers in nutrition · 2026Article
- Association between HbA1c/HDL-C ratio and diabetic foot ulcer: a cross-sectional study based on the Han population in Northwest China.Frontiers in nutrition · 2026Article
- Nonlinear association of HbA1c/HDL-C ratio with heart failure in adults: a large cross-sectional study.Frontiers in cardiovascular medicine · 2026Article
- Association between remnant cholesterol-based lipid indicators and testosterone deficiency in middle-aged and older men: a cross-sectional study.Frontiers in endocrinology · 2026Article
- Longitudinal investigation of the HbA1c/HDL-c ratio as a potential biomarker of cognitive decline among Chinese older adults: evidence from CHARLS.BMC public health · 2025Article
- Association between lipid profiles and early clinical outcomes in acute ischemic stroke: a single-center cohort study in the Chinese population.BMC neurology · 2025Article
- Integrated metabolic-inflammatory risk assessment: HbA1c/HDL-c and hsCRP-to-albumin ratios synergistically predict major adverse cardiovascular events in post-PCI STEMI patients.Lipids in health and disease · 2025Article
- Data-driven analysis of the relationship between the HbA1c/HDL-C ratio and coronary artery calcification: a cross-sectional study.Scientific reports · 2025Article
- The HbA1c/HDL-C ratio as a screening indicator of NAFLD in U.S. adults: a cross-sectional NHANES analysis (2017-2020).BMC gastroenterology · 2025Article
- The association between Glycated Hemoglobin to High Density Lipoprotein Cholesterol Ratio and risk of cardiovascular diseases caused death among adult cancer survivors: evidence from NHANES 1999-2018.Lipids in health and disease · 2025Article
- Article
- Association of HbA1c/HDL-C ratio and depression with cardiometabolic multimorbidity in middle-aged and older adults: a nationwide prospective cohort study.Frontiers in nutrition · 2025Article
- Association betweenFrontiers in nutrition · 2025Article
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Authors and funding
6 authors.
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Abstract
backgroundStroke 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.
methodsOur 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.
resultsIn 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.
conclusionsElevated 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.
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