{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T23:11:58Z","timestamp":1793920318547,"version":"4.8.0"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hypertension and diabetes are major drivers of cardiovascular disease (CVD), and their coexistence confers excess risk. This study aimed to develop a hemoglobin A1c (HbA1c)-systolic blood pressure (SBP) index (HSI) to simultaneously capture glucose and blood pressure status and investigate the associations of baseline and cumulative HSI with incident CVD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data were drawn from three population-based cohorts: the China Health and Retirement Longitudinal Study (CHARLS), the English Longitudinal Study of Ageing (ELSA), and the US Health and Retirement Study (HRS). Baseline HSI was calculated as HbA1c (%) \u00d7 SBP (mmHg)\/100. Cumulative HSI was derived from repeated measurements weighted by time intervals. Cause-specific Cox proportional hazards models were used to investigate linear associations of baseline and cumulative HSI with incident CVD. Additionally, restricted cubic splines were used to assess nonlinear relationships.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 6,822 participants from CHARLS, 3,640 from ELSA, and 5,709 from HRS were included, with median follow-up of 9.0, 10.0, and 12.3 years, respectively. Across all three cohorts, the combination of elevated HbA1c and SBP was associated with the highest CVD risk. Higher baseline HSI were significantly associated with increased risks of CVD in the CHARLS (hazard ratio [HR] per 1 standard deviation [SD] increase =1.16, 95% confidence interval [CI] 1.11\u20131.22), ELSA (1.13, 95% CI 1.06\u20131.21), and HRS (1.14, 95% CI 1.10\u20131.19). Cumulative HSI levels were also significantly associated with elevated CVD risk (CHARLS: HR per 1 SD increase = 1.19, 95% CI 1.12\u20131.26; ELSA: 1.14, 95% CI 1.04\u20131.26; HRS, 1.15, 95% CI 1.08\u20131.22). No evidence of nonlinearity between baseline HSI and CVD was detected. The associations were almost consistent across demographic and clinical subgroups. The predictive performance of HSI was superior to HbA1c or SBP alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>HSI, a simple composite of HbA1c and SBP, was consistently associated with incident CVD across three international cohorts. Its predictive ability exceeded that of HbA1c or SBP alone, highlighting it as a pragmatic tool for integrated cardiometabolic risk assessment. The findings warrant further clinical validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1718936","type":"journal-article","created":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T05:33:43Z","timestamp":1771392823000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Hemoglobin A1c-systolic blood pressure index as a novel predictor of cardiovascular disease: evidence from three prospective cohorts"],"prefix":"10.3389","volume":"17","author":[{"given":"Ruiqi","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Radiology, Kunshan First People\u2019s Hospital Affiliated to Jiangsu University","place":["Kunshan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuelian","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Radiology, Kunshan First People\u2019s Hospital Affiliated to Jiangsu University","place":["Kunshan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjun","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Second Affiliated Hospital of Nanjing Medical University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boyang","family":"Xiang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Second Affiliated Hospital of Nanjing Medical University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shushu","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Second Affiliated Hospital of Nanjing Medical University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2023.11.007","article-title":"Global burden of cardiovascular diseases and risks, 1990-2022","volume":"82","author":"Mensah","year":"2023","journal-title":"J Am Coll Cardiol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2022.11.005","article-title":"The global burden of cardiovascular diseases and risk: A compass for future health","volume":"80","author":"Vaduganathan","year":"2022","journal-title":"J Am Coll Cardiol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000001078","article-title":"Life\u2019s essential 8: updating and enhancing the american heart association\u2019s construct of cardiovascular health: A presidential advisory from the american heart association","volume":"146","author":"Lloyd-Jones","year":"2022","journal-title":"Circulation"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000001184","article-title":"Cardiovascular-kidney-metabolic health: A presidential advisory from the american heart association","volume":"148","author":"Ndumele","year":"2023","journal-title":"Circulation"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000001186","article-title":"A synopsis of the evidence for the science and clinical management of cardiovascular-kidney-metabolic (CKM) syndrome: A scientific statement from the american heart association","volume":"148","author":"Ndumele","year":"2023","journal-title":"Circulation"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.2337\/dca24-0118","article-title":"Associations of concurrent hypertension and type 2 diabetes with mortality outcomes: A prospective study of U.S. Adults","volume":"48","author":"Yuan","year":"2025","journal-title":"Diabetes Care"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e026192","DOI":"10.1161\/jaha.122.026192","article-title":"Interaction of blood pressure and glycemic status in developing cardiovascular disease: analysis of a nationwide real-world database","volume":"12","author":"Suzuki","year":"2023","journal-title":"J Am Heart Assoc"},{"key":"B8","doi-asserted-by":"publisher","first-page":"3912","DOI":"10.1093\/eurheartj\/ehae178","article-title":"2024 ESC Guidelines for the management of elevated blood pressure and hypertension","volume":"45","author":"McEvoy","year":"2024","journal-title":"Eur Heart J"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000001356","article-title":"2025 AHA\/ACC\/AANP\/AAPA\/ABC\/ACCP\/ACPM\/AGS\/AMA\/ASPC\/NMA\/PCNA\/SGIM guideline for the prevention, detection, evaluation and management of high blood pressure in adults: A report of the american college of cardiology\/american heart association joint committee on clinical practice guidelines","volume":"152","author":"Jones","year":"2025","journal-title":"Circulation"},{"key":"B10","doi-asserted-by":"publisher","first-page":"S20","DOI":"10.2337\/dc24-S002","article-title":"2. 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