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This study aimed to investigate the relationship between HbA1c and global longitudinal strain (GLS) in nondiabetic and prediabetic subjects. A subpopulation of the Northern Finland Birth Cohort 1966 took part in a follow\u2010up, including extensive medical examination and echocardiography (<jats:italic>n<\/jats:italic>\u2009=\u20091155), at the age of 46. The final study population included 636 healthy subjects. Normal HbA1c levels were divided into sex\u2010specific tertiles and prediabetes, which were later pooled together. Univariate analysis after adjusted with covariates was used to compare cardiac function in HbA1c groups. HbA1c groups were defined as low (30.9\u2009\u00b1\u20091.7\u2009mmol\/mol, <jats:italic>n<\/jats:italic>\u2009=\u2009190), medium (34.6\u2009\u00b1\u20091.0\u2009mmol\/mol, <jats:italic>n<\/jats:italic>\u2009=\u2009189), high (37.4\u2009\u00b1\u20091.0\u2009mmol\/mol, <jats:italic>n<\/jats:italic>\u2009=\u2009190) and prediabetes (41.0\u2009\u00b1\u20091.3\u2009mmol\/mol, <jats:italic>n<\/jats:italic>\u2009=\u200967) groups. Subjects with abnormal absolute GLS (&lt;18) comprised 7.4%, 12.7%, 21.1%, and 17.9% (main effect <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01) of low, medium, high HbA1c and prediabetes groups, respectively. HbA1c was not associated with any cardiac structure variables. High normal HbA1c levels and prediabetes are associated with reduced myocardial contractility in a healthy middle\u2010aged population, potentially predicting the development of heart failure.<\/jats:p>","DOI":"10.14814\/phy2.70429","type":"journal-article","created":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T14:48:46Z","timestamp":1750171726000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cardiac structure and function across the continuum of glucose metabolism"],"prefix":"10.14814","volume":"13","author":[{"given":"Tommi","family":"Gr\u00f6nlund","sequence":"first","affiliation":[{"name":"Research Unit of Biomedicine and Internal Medicine University of Oulu  Oulu Finland"},{"name":"Medical Research Center Oulu, Oulu University Hospital and University of Oulu  Oulu Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kari","family":"Kaikkonen","sequence":"additional","affiliation":[{"name":"Research Unit of Biomedicine and Internal Medicine University of Oulu  Oulu Finland"},{"name":"Medical Research Center Oulu, Oulu University Hospital and University of Oulu  Oulu Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. 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