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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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Our investigation utilized data from the China Health and Retirement Longitudinal Study cohort (2011\u20132018). 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\u20132015) and new stroke incidence (2015\u20132018). Additionally, smoothed curve fitting, subgroup analyses, and interaction tests were conducted to ensure the robustness of the findings.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>In 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\u20131.45). 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\u20132.77). In the longitudinal analysis of 5,165 participants, 336 cases of new-onset stroke were identified over a follow-up period of 7\u00a0years. 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\u20131.29). 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\u20132.24) in T2 and 1.54 (95% CI: 1.08\u20132.19) 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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Elevated 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.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12944-025-02438-4","type":"journal-article","created":{"date-parts":[[2025,1,25]],"date-time":"2025-01-25T10:28:06Z","timestamp":1737800886000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Association between the hemoglobin A1c\/High-density lipoprotein cholesterol ratio and stroke incidence: a prospective nationwide cohort study in China"],"prefix":"10.1186","volume":"24","author":[{"given":"Chaojuan","family":"Huang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongtao","family":"You","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuyang","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ligang","family":"Fan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingliang","family":"Feng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naiyuan","family":"Shao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,1,25]]},"reference":[{"issue":"10446","key":"2438_CR1","doi-asserted-by":"publisher","first-page":"2820","DOI":"10.1016\/s0140-6736(24)00642-1","volume":"403","author":"NA Hilkens","year":"2024","unstructured":"Hilkens NA, Casolla B, Leung TW, de Leeuw FE. 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