{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T16:58:00Z","timestamp":1790787480050,"version":"4.1.0"},"reference-count":42,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Diabetes mellitus (DM) is associated with left ventricular remodeling and incident heart failure, but the association between glycated hemoglobin A1c (HbA1c) and subclinical cardiac disease is not established. We aimed to determine the associations between HbA1c and (1) echocardiographic measures of left ventricular structure and function, and (2) cardiovascular biomarkers: cardiac troponin T, NT\u2010proBNP (N\u2010terminal pro\u2010B\u2010type natriuretic peptide), and CRP (C\u2010reactive protein).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Participants (n=3688) born in 1950 from the population\u2010based ACE (Akershus Cardiac Examination) 1950 Study were classified as DM (HbA1c\u22656.5% or self\u2010reported DM), pre\u2010DM (HbA1c 5.7%\u20136.5%), and no\u2010DM (HbA1c&lt;5.7%). DM, pre\u2010DM, and no\u2010DM were classified in 380 (10%), 1630 (44%), and 1678 (46%) participants, respectively. Mean age was 63.9\u00b10.7\u00a0years, mean body mass index was 27.2\u00b14.4\u00a0kg\/m\n              <jats:sup>2<\/jats:sup>\n              , and 49% were women. Higher HbA1c was associated with worse left ventricular systolic (ejection fraction and global longitudinal strain) and diastolic (E\/e'\u2010ratio) function, myocardial injury (cardiac troponin T), inflammation (CRP), and impaired neurohormonal homeostasis (NT\u2010proBNP) (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001 in unadjusted and\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01 in adjusted analysis for all). The associations between HbA1c and cardiovascular biomarkers were independent of the echocardiographic variables, and vice versa. Associations were nonlinear (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.05 for nonlinearity) and appeared stronger in the pre\u2010DM range of HbA1c than the no\u2010DM and DM range.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">HbA1c was associated with indexes of subclinical cardiovascular disease, and this was more pronounced in pre\u2010DM. Our results suggest that cardiovascular preventive measures should be considered also in subjects with hyperglycemia and HbA1c below the established DM cutoff.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Registration<\/jats:title>\n            <jats:p xml:lang=\"en\">clinicaltrials.gov. Identifier: NCT01555411.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.120.020447","type":"journal-article","created":{"date-parts":[[2021,5,17]],"date-time":"2021-05-17T09:42:02Z","timestamp":1621244522000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":17,"title":["Diagnostic Thresholds for Pre\u2013Diabetes Mellitus and Diabetes Mellitus and Subclinical Cardiac Disease in the General Population:\n            <i>Data From the ACE 1950 Study<\/i>"],"prefix":"10.1161","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5871-1804","authenticated-orcid":false,"given":"Peder L.","family":"Myhre","sequence":"first","affiliation":[{"name":"Department of CardiologyAkershus University Hospital L\u00f8renskog Norway"},{"name":"Department of Multidisciplinary Laboratory Medicine and Medical BiochemistryAkershus University Hospital L\u00f8renskog 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