Glycated Hemoglobin as a Predictor of Dyslipidemia and Cardiovascular Risk in Type 2 Diabetes Mellitus

Saad AL-Fawaeir ¹*

This study showed the critical role of HbA1c levels and lipid ratios in evaluating cardiovascular risk among patients with Type 2 diabetes.

Abstract

Background: Type 2 Diabetes Mellitus (T2DM) is a globally prevalent metabolic disorder that significantly increases the risk of cardiovascular disease (CVD) through mechanisms such as dyslipidemia, characterized by elevated triglycerides, low high-density lipoprotein (HDL) levels, and small dense low-density lipoprotein (LDL) particles. Glycated hemoglobin (HbA1c) is a key biomarker of glucose control and has been associated with CVD risk. Methods: This cross-sectional study aimed to evaluate the relationship between glycated hemoglobin (HbA1c) levels and lipid profiles, specifically lipid ratios, in a Jordanian population with type 2 diabetes mellitus (T2DM). A total of 140 patients with T2DM and 20 healthy controls participated. Blood samples were analyzed for fasting blood sugar (FBS), HbA1c, total cholesterol, triglycerides, high-density lipoprotein (HDL-C), and low-density lipoprotein (LDL-C) levels. HbA1c levels were grouped: A (≤7%), B (7–9%), C (9–11%), and D (>11%). Results: The T2DM group showed significantly elevated HbA1c levels compared to controls. Patients with higher HbA1c levels (Groups C and D) exhibited abnormal lipid profiles, including increased total cholesterol and triglycerides and reduced HDL-C. The LDL-C/HDL-C ratio was notably higher in patients with HbA1c >9%, indicating a potential elevated cardiovascular risk. This correlation between HbA1c and lipid profile abnormalities supports the association between poor glycemic control and lipid metabolism dysregulation. Conclusion: HbA1c levels are significantly associated with dyslipidemia, and lipid ratios serve as sensitive indicators for cardiovascular risk in T2DM patients. These findings underscore the clinical importance of monitoring HbA1c and lipid ratios to improve risk assessment and guide intervention strategies in high-risk populations.

Keywords: Type 2 Diabetes Mellitus (T2DM), Glycated Hemoglobin (HbA1c), Lipid Profiles, Cardiovascular Risk, Dyslipidemia.

References

Ahn, C. H., & Choi, S. H. (2015). New drugs for treating dyslipidemia: Beyond statins. Diabetes & Metabolism Journal, 39(2), 87–94.

American Diabetes Association. (2010). Diagnosis and classification of diabetes mellitus. Diabetes Care, 33(Supplement_1), S62–S69.

Bener, A., et al. (2007). Association between type 2 diabetes mellitus and Helicobacter pylori infection. Diabetes & Metabolism, 18(4), 225–229.

Berry, C., et al. (2007). Coronary heart disease in patients with diabetes: Part I: Recent advances in prevention and noninvasive management. Journal of Diabetes and Its Complications, 49(6), 631–642.

Chan, W., et al. (2005). Triglyceride predicts cardiovascular mortality and its relationship with glycemia and obesity in Chinese type 2 diabetic patients. Diabetes/Metabolism Research and Reviews, 21(2), 183–188.

Choudhury, A. A., & Rajeswari, V. D. (2021). Gestational diabetes mellitus: Metabolic and reproductive disorder. Biomedicine & Pharmacotherapy, 143, 112183.

Faulkner, M. S., et al. (2006). Total homocysteine, diet, and lipid profiles in type 1 and type 2 diabetic and nondiabetic adolescents. The Journal of Cardiovascular Nursing, 21(1), 47.

Fleg, J. L., et al. (2005). Accelerated longitudinal decline of aerobic capacity in healthy older adults. Journal of the American College of Cardiology, 112(5), 674–682.

Friedewald, W. T., et al. (1972). Estimating the concentration of low-density lipoprotein cholesterol in plasma without the preparative ultracentrifuge. Clinical Chemistry, 18(6), 499–502.

Gao, L., et al. (2008). An investigation of the population impact of variation in HbA1c levels in older people in England and Wales: From a population-based multi-centre longitudinal study. Diabetes, Obesity and Metabolism, 8(1), 1–11.

Garimella, S., et al. (2016). Effect of metformin on lipid profile of type II diabetes. International Journal of Integrated Medical Sciences, 3(11), 449–453.

Giansanti, R., et al. (1999). Coronary heart disease, type 2 diabetes mellitus, and cardiovascular disease risk factors: A study on a middle-aged and elderly population. Archives of Gerontology and Geriatrics, 29(2), 175–181.

Gimeno-Orna, J., et al. (2005). The usefulness of total cholesterol/HDL-cholesterol ratio in managing diabetic dyslipidemia. Diabetes & Metabolism, 22(1), 26–31.

Gregg, E. W., et al. (2000). Diabetes and physical disability among older U.S. adults. Diabetes Care, 23(9), 1272–1277.

Hameed, U. A., et al. (2012). Resistance training leads to clinically meaningful improvements in glycemia and muscular strength control in untrained middle-aged patients with type 2 diabetes mellitus. Journal of Diabetes Research, 4(8), 336.

Hammed, I. K., et al. (2012). Glycated hemoglobin as a dual biomarker: Association between HbA1c and dyslipidemia in type 2 diabetic patients. Indian Journal of Endocrinology and Metabolism, 54(1), 88–92.

Harris, L., et al. (1998). Premature peripheral vascular disease: Clinical profile and abnormal lipid peroxidation. Journal of Vascular Surgery, 6(2), 188–193.

Howard, B. V., & Howard, W. J. J. (2005). Pathophysiology and treatment of lipid disorders in diabetes. Journal of Diabetes and Its Complications, 19, 563–584.

Joslin, E. P., & Kahn, C. R. (2005). Joslin's Diabetes Mellitus (C. R. Kahn, Ed.). Lippincott Williams & Wilkins.

Karalis, D. G., & Disease, P. R. J. F. A. I. T. (2008). The role of lipid-lowering therapy in preventing coronary heart disease in patients with type 2 diabetes. Journal of Clinical Lipidology, 31(6), 241–248.

Katsarou, A., et al. (2017). Type 1 diabetes mellitus. Nature Reviews Disease Primers, 3(1), 1–17.

Khan, H., et al. (2007). Association between glycaemic control and serum lipid profile in type 2 diabetic patients: HbA1c predicts dyslipidemia. Clinical and Experimental Medicine, 7, 24–29.

Ko, G., et al. (1998). Glycated hemoglobin and cardiovascular risk factors in Chinese subjects with standard glucose tolerance. Diabetes Research and Clinical Practice, 15(7), 573–578.

Kohrt, W. M., et al. (1993). Insulin resistance in aging is related to abdominal obesity. Diabetes, 42(2), 273–281.

Kumar, A., et al. (2011). Lipid ratio as a helpful indicator in predicting risk of myocardial infarction in elderly normolipidemic patients: A report from a multicenter study. Asian Pacific Journal of Tropical Disease, 1(2), 123–126.

Kumar, R., et al. (2020). A review on diabetes mellitus: Type1 & Type2. Journal of Medical Research and Health Sciences, 9(10), 838-850.

Lemieux, I., et al. (2001). Total cholesterol/HDL cholesterol ratio vs LDL cholesterol/HDL cholesterol ratio as indices of ischemic heart disease risk in men: The Quebec Cardiovascular Study. Canadian Medical Association Journal, 161(22), 2685-2692.

Malone, J. I., & Hansen, B. C. (2019). Does obesity cause type 2 diabetes mellitus (T2DM)? Or is it the opposite? Pediatric Diabetes, 20(1), 5–9.

Nickerson, H. D., & Dutta, S. (2012). Diabetic complications: Current challenges and opportunities. Journal of Clinical and Translational Research, 5, 375–379.

Olokoba, A. B., et al. (2012). Type 2 diabetes mellitus: A review of current trends. Oman Medical Journal, 27(4), 269.

Padhi, S., et al. (2020). Type II diabetes mellitus: A review on recent drug-based therapeutics. Biomedicine & Pharmacotherapy, 131, 110708.

Pedersen, B., et al. (2003). Possible beneficial role of exercise in modulating low-grade inflammation in the elderly. International Journal of Obesity, 13(1), 56-62.

Puchulu, F. M. (2018). Definition, diagnosis, and classification of diabetes mellitus. Diabetes & Metabolism, 7–18.

Ravipati, G., et al. (2006). Association of hemoglobin A1c level with the severity of coronary artery disease in patients with diabetes mellitus. The American Journal of Cardiology, 97(7), 968-969.

Ridker, P. M., et al. (2005). Non–HDL cholesterol, apolipoproteins A-I and B100, standard lipid measures, lipid ratios, and CRP as risk factors for cardiovascular disease in women. JAMA, 294(3), 326-333.

Rohlfing, C. L., et al. (2002). Defining the relationship between plasma glucose and HbA1c: Analysis of glucose profiles and HbA1c in the Diabetes Control and Complications Trial. Diabetes Care, 25(2), 275-278.

Ryan, A., & Nicklas, B. J. (1999). Age-related changes in fat deposition in mid-thigh muscle in women: Relationships with metabolic cardiovascular disease risk factors. International Journal of Obesity, 23(2), 126–132.

Schofield, J. D., et al. (2016). Diabetes dyslipidemia. Diabetes Therapy, 7, 203-219.

Selvin, E., et al. (2005). Glycemic control and coronary heart disease risk in persons with and without diabetes: The atherosclerosis risk in communities study. Archives of Internal Medicine, 165(16), 1910-1916.

Shai, I., et al. (2004). Multivariate assessment of lipid parameters as predictors of coronary heart disease among postmenopausal women: Potential implications for clinical guidelines. Circulation, 110(18), 2824-2830.

Soumya, D., & Srilatha, B. (2011). Late-stage complications of diabetes and insulin resistance. Journal of Diabetes and Metabolism, 2(9), 1000167.

Sultan, A., et al. (2006). Primary prevention of cardiovascular events and type 2 diabetes: Should we prioritize our interventions? Diabetes & Metabolism, 32(6), 559-567.

Tan, M. H., et al. (2004). Pioglitazone reduces the atherogenic index of plasma in patients with type 2 diabetes. Diabetes Research and Clinical Practice, 50(7), 1184–1188.

VinodMahato, R., et al. (2011). Association between glycaemic control and serum lipid profile in type 2 diabetic patients: Glycated hemoglobin as a dual biomarker. International Journal of Diabetes in Developing Countries, 22(3), 99-104.

Wild, S., et al. (2004). Global prevalence of diabetes: Estimates for 2000 and projections for 2030. Diabetes Care, 27(5), 1047–1053.

Williams, R., et al. (2020). Global and regional estimates and projections of diabetes-related health expenditure: Results from the International Diabetes Federation Diabetes Atlas. Diabetes Research and Clinical Practice, 162, 108072.

Yan, Z., et al. (2012). Association of glycosylated hemoglobin level with lipid ratio and individual lipids in type 2 diabetic patients. Asian Pacific Journal of Tropical Medicine, 5(6), 469-471.

Yang, D., et al. (2011). The correlation between lipids ratio and degree of coronary artery stenosis. High Blood Pressure & Cardiovascular Prevention, 18, 53-56.