Association of HbA1c Levels with Major Adverse Cardiovascular Events (MACE) in Patients with Type 2 Diabetes at Phon Thong Hospital, Roi Et Province

Abstract

Background and objective: Type 2 diabetes mellitus is a major risk factor for cardiovascular disease, which remains the leading cause of morbidity and mortality among patients with diabetes. However, evidence regarding the association between glycemic control, as measured by HbA1c, and major adverse cardiovascular events (MACE) in community hospital settings is limited. This study aimed to evaluate the association between HbA1c levels and MACE among patients with type 2 diabetes at Phon Thong Hospital, Roi Et province.

Methods: A retrospective cohort study was conducted using medical records and electronic databases of patients with type 2 diabetes receiving care at the chronic disease clinic between January 1, 2023 and December 31, 2025. Associations between HbA1c levels and MACE were analyzed using univariable and multivariable logistic regression analyses. Statistical significance was defined as p-value < 0.05.

Results: A total of 572 patients were included, with a mean age of 65.46 ± 8.88 years; 71% were female. The mean HbA1c level was 9.29 ± 2.04%. The proportion of MACE increased significantly with higher HbA1c categories (p for trend = 0.008). In multivariable analysis, each 1% increase in HbA1c was associated with a higher risk of MACE (adjusted OR = 1.23; 95%CI: 1.07–1.40; p = 0.003). Male sex and higher LDL-C levels were independently associated with increased MACE risk, whereas metformin use was associated with reduced risk.

Conclusion: Higher HbA1c levels were associated with an increased risk of major adverse cardiovascular events among patients with type 2 diabetes in a community hospital setting, demonstrating a dose–response relationship. These findings highlight the importance of sustained glycemic control alongside comprehensive cardiovascular risk management to prevent MACE in patients with type 2 diabetes.