A-004 Association between chronic hyperglycemia and elevated cardiovascular risk: A multivariate analysis in type 2 diabetes

Abstract

The reduction of cardiovascular morbidity and the prevention of premature mortality constitute the therapeutic cornerstones in the management of type 2 diabetes mellitus. While conventional clinical approaches have historically prioritized the optimization of anthropometric parameters and lipid profiles, contemporary evidence establishes that cumulative glycemic burden and glycemic variability are the principal determinants of the excess risk for major adverse cardiovascular events (MACE). For this reason, this study sought to assess the magnitude of the impact of chronic hyperglycemia (HbA1c > 7.0%), evaluating whether its capacity to predict elevated cardiovascular risk surpasses more than conventional anthropometric and lipid factors. A cross-sectional study was conducted in patients with type 2 diabetes who attended the IMSS-Bienestar "Dr. Guillermo Soberón Acevedo" clinic in Chilpancingo, Guerrero, Mexico, between November 2025 and February 2026. Glycemic status was used to prospectively stratify the study population into controlled (HbA1c =7.0%) and uncontrolled (HbA1c >7.0%) patients. The Globorisk calculator, which incorporates factors such as sex, age, smoking status, systolic blood pressure, and total cholesterol, was used to calculate 10-year cardiovascular risk. Patients were divided into four clinical risk groups: Very High (=50%), High (30-49%), Moderate (10-29%), and Low (<10%). A multivariate logistic regression model was used for inferential analysis, controlling for the independent variables of sex, body mass index (BMI) and degree of pharmacotherapeutic adherence (measured by a validated 8-item self-administered questionnaire). The results showed that the 120 patients in this study had a mean age of 59 years and were predominantly female (73.0%). Furthermore, 48.3% of the patients (n=58/120) had uncontrolled glycemia. Metabolic dysregulation was evident in both sexes, with 50.0% of men and 47.7% of women having suboptimal HbA1c levels (p=0.82). Risk analysis eliminated any discernible gender disparity in this burden. Uncontrolled HbA1c was the most powerful independent risk factor when the multivariate model was used to predict moderate to very high cardiovascular risk. The probability of presenting a dangerous risk profile tripled when the 7.0% threshold was exceeded (OR 3.08; 95% CI: 1.34-7.04; p=0.008). The influence of BMI, which demonstrated a paradoxical inverse association (OR: 0.91; 95% CI: 0.83-0.99; p=0.025), proved inferior to this effect. Furthermore, a notable protective trend was observed in therapeutic adherence (OR: 0.49; 95% CI: 0.20-1.19; p=0.114). Uncontrolled hyperglycemia is unequivocally the most aggressive cardiovascular risk factor, affecting nearly half of the studied population and tripling the risk compared to those with controlled glycemia. Given that the impact of glycemic load (OR 3.08) far exceeds that of traditional anthropometric measurements, clinical interventions should prioritize intensive glycemic control as the primary mechanism to mitigate vulnerability in this demographic group.