Factor · Blood Levels

HbA1c

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Glycated hemoglobin, diabetes, and cardiovascular risk in nondiabetic adults

Strong
HbA1cObservational evidenceReverse causation risk
Observational study
In nondiabetic adults, glycated hemoglobin showed a J-shaped association with death from any cause, remaining significant after adjustment for fasting glucose, in the ARIC cohort (n=11,092)
Causal status: Causal support strong for diabetes/CVD risk; all-cause mortality relationship J-shaped, so causal direction less clear at low HbA1c
Reliability / bias notes: J-shaped curve means very low HbA1c also carries excess mortality risk, likely reflecting reverse causation/frailty; overlaps with the separate diagnosed-diabetes question, so effects are kept modest to avoid double-counting the same underlying condition
Selvin et al · N Engl J Med · 2010 · PMID 20200384
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