Abstract 17128: Sleep Irregularity is Associated With Increased All-Cause Mortality

Introduction: Circadian rhythm disruptions are associated with increased cardiovascular disease risk. We aim to investigate if day-to-day variation in sleep duration and onset of sleep are associated with cardiovascular and all-cause mortality. Methods: 388 subjects with sleep data from Midlife in the United States(MIDUS) 2 Biomarker study(2004-09) were included. Objective sleep data was measured using the Actiwatch® device. Sleep onset, duration, sleep-wake cycles were collected for 7 consecutive days. Mean and standard deviations in sleep duration and time of onset of sleep over 7 days were calculated to assess for sleep irregularity and tertiles created. Mortality data was available with a follow up until December 2016. Cox proportional regression analysis was performed. Competing risk analysis for cardiovascular mortality was done with fine and gray subdistribution hazard. Results: Mean age 54.56±11.79 years; females 230(59.3%). BMI 30.56±7.06 kg/m 2. Over a median of 8.6 years follow up, 37 patients died including 10 deaths due to cardiovascular mortality. Sleep duration SD tertiles ranges were: 11-41 minutes, 42-67 minutes and 68-257 minutes in lowest to highest tertiles respectively. There was no statistically significant increase in cardiovascular mortality with variation in sleep duration. Tertile 3 vs 1: HR 4.00(0.45-35.48,p 0.21), but there was statically significant increase in all-cause mortality tertile 2vs1 and 3vs1 -HR 3.63(1.19-10.99, p 0.02), HR 3.99(1.33-11.94, p 0.01) respectively. Fully adjusted model showed tertile 2vs1 and 3vs1 HR 3.51(1.12-10.99, p 0.03), HR 4.85(1.52-15.49, P < 0.01) respectively. Conclusions: Day to day variation in sleep duration is associated with increased all-cause mortality but not cardiovascular mortality after adjusting for mean sleep duration, inflammation, diabetes, age, BMI, renal function and blood pressure.

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Abstract MP20: Dietary Quality and Mortality among Myocardial Infarction Survivors

Circulation ◽

10.1161/circ.127.suppl_12.amp20 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Shanshan Li ◽

Stephanie E Chiuve ◽

Alan Flint ◽

Jennifer Pai ◽

John Forman ◽

...

Keyword(s):

Myocardial Infarction ◽

Healthy Eating ◽

Cardiovascular Mortality ◽

Disease Risk ◽

The United States ◽

Healthy Eating Index ◽

Dietary Quality ◽

Alternative Healthy Eating Index ◽

All Cause Mortality

Background: Despite the increase in the prevalence of non-fatal Myocardial Infarction (MI) in the United States, evidence based recommendations for diet post-MI are limited and established primarily from studies of short duration. Objective: Using data from the Nurses’ Health Study and the Health Professional Follow-Up Study, we assessed dietary quality, measured by the recently developed Alternative Healthy Eating Index 2010 (AHEI2010), to evaluate diet post-MI and changes in diet from pre- to post-MI in relation to all-cause and cardiovascular mortality. Method and Results: We included 2,258 women and 1,840 men who were free of cardiovascular disease, stroke or cancer at the time of enrollment (1976 for women and 1986 for men), and survived a first MI during the follow up through 2008. Individuals were free of stroke at the time of initial MI onset, provided both pre-MI exposure information and at least one post-MI food frequency questionnaire (FFQ). During follow-up, we confirmed 682 all cause and 336 cardiovascular deaths for women, and 451 all cause and 222 cardiovascular deaths for men. The median survival time after initial MI was 8.7 years for women and 9.0 years for men. The Alternative Healthy Eating Index 2010 (AHEI2010) was developed based on a comprehensive review of the relevant literature to determine foods and nutrients most consistently associated with lower chronic disease risk and has the following 11 components: vegetables, fruits, nuts and legumes, red meat and processed meats, sugar-sweetened beverages, alcohol, polyunsaturated fat (no EPA or DHA), trans fat, omega-3 fat (EPA and DHA), whole grains and sodium intake. We used Cox proportional hazards models with time since initial MI onset as the underlying time scale and adjusted for medication use, medical history, and lifestyles factors. After pooling the results from both cohorts, the adjusted HR was 0.76 (95%CI: 0.60-0.96) for all-cause mortality and 0.74 (95%CI: 0.51-1.05) for cardiovascular mortality, between the highest and lowest quintile of the AHEI2010. A greater increase in AHEI2010 score from the pre- to post-MI period comparing Q5 (highest increase) vs. Q1 (lowest increase), was significantly associated with lower all-cause mortality (pooled HR= 0.71, 95%CI: 0.55-0.90) and cardiovascular mortality (pooled HR= 0.59, 95%CI: 0.41- 0.86). Conclusions: Our results suggest that post-MI patients who consume a higher quality diet, which has been associated with lower risk of CHD in primary prevention, have lower all-cause mortality. The current dietary recommendations for secondary prevention among MI patients need to be updated to reflect current scientific knowledge and to offer comprehensive advice on overall healthy diet quality.

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Plasma Dehydroepiandrosterone Sulfate and Cardiovascular Disease Risk in Older Men and Women

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgaa518 ◽

2020 ◽

Vol 105 (12) ◽

pp. e4304-e4327 ◽

Cited By ~ 1

Author(s):

Xiaoming Jia ◽

Caroline Sun ◽

Olive Tang ◽

Ivan Gorlov ◽

Vijay Nambi ◽

...

Keyword(s):

Cardiovascular Disease ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Dehydroepiandrosterone Sulfate ◽

Mortality Data ◽

Atherosclerosis Risk In Communities ◽

Percentage Decrease ◽

Increased Risk ◽

Study Population

Abstract Context Lower dehydroepiandrosterone-sulfate (DHEA-S) levels have been inconsistently associated with coronary heart disease (CHD) and mortality. Data are limited for heart failure (HF) and association between DHEA-S change and events. Objective Assess associations between low DHEA-S/DHEA-S change and incident HF hospitalization, CHD, and mortality in older adults. Design DHEA-S was measured in stored plasma from visits 4 (1996-1998) and 5 (2011-2013) of the Atherosclerosis Risk in Communities study. Follow-up for incident events: 18 years for DHEA-S level; 5.5 years for DHEA-S change. Setting General community. Participants Individuals without prevalent cardiovascular disease (n = 8143, mean age 63 years). Main Outcome Measure Associations between DHEA-S and incident HF hospitalization, CHD, or mortality; associations between 15-year change in DHEA-S (n = 3706) and cardiovascular events. Results DHEA-S below the 15th sex-specific percentile of the study population (men: 55.4 µg/dL; women: 27.4 µg/dL) was associated with increased HF hospitalization (men: hazard ratio [HR] 1.30, 95% confidence interval [CI], 1.07-1.58; women: HR 1.42, 95% CI, 1.13-1.79); DHEA-S below the 25th sex-specific percentile (men: 70.0 µg/dL; women: 37.1 µg/dL) was associated with increased death (men: HR 1.12, 95% CI, 1.01-1.25; women: HR 1.19, 95% CI, 1.03-1.37). In men, but not women, greater percentage decrease in DHEA-S was associated with increased HF hospitalization (HR 1.94, 95% CI, 1.11-3.39). Low DHEA-S and change in DHEA-S were not associated with incident CHD. Conclusions Low DHEA-S is associated with increased risk for HF and mortality but not CHD. Further investigation is warranted to evaluate mechanisms underlying these associations.

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Cardiovascular and all-cause mortality attributable to loneliness in older Swedish men and women.

10.21203/rs.2.22585/v2 ◽

2020 ◽

Author(s):

Masuma Novak ◽

Margda waern ◽

Lena Johansson ◽

Anna Zettergren ◽

Lina Ryden ◽

...

Keyword(s):

Cardiovascular Mortality ◽

Cox Regression ◽

Mortality Data ◽

Men And Women ◽

Face To Face ◽

Risk Of Mortality ◽

Increased Risk ◽

All Cause Mortality ◽

Adjusted Model

Abstract Background. This study examined whether loneliness predicts cardiovascular- and all-cause mortality in older men and women. Methods. Baseline data from the Gothenburg H70 Birth Cohort Studies, collected during 2000 on 70-year-olds born 1930 and living in Gothenburg were used for analysis (n=524). Mortality data were analyzed until 2012 through Swedish national registers. Results. Perceived loneliness was reported by 17.1% of the men and 30.9% of the women in a face-to-face interview with mental health professional. A total of 142 participants died during the 12-year follow-up period, with 5 334 person-years at risk, corresponding to 26.6 deaths/1000 person-years. Cardiovascular disease accounted for 59.2% of all deaths. The cumulative rates/1000 person-years for cardiovascular mortality were 20.8 (men) and 11.5 (women), and for all-cause mortality 33.8 (men) and 20.5 (women), respectively. In Cox regression models, no significant increased risk of mortality was seen for men with loneliness compared to men without loneliness (cardiovascular mortality HR 1.52, 95% CI 0.78 - 2.96; all-cause HR 1.32, 95% CI 0.77 - 2.28). Increased risk of cardiovascular mortality was observed in women with loneliness compared to those without (HR 2.25 95% CI 1.14 - 4.45), and the risk remained significant in a multivariable-adjusted model (HR 2.42 95% CI 1.04 - 5.65). Conclusions. Loneliness was shown to be an independent predictor of cardiovascular mortality in women. We found no evidence to indicate that loneliness was associated with an increased risk of either cardiovascular- or all-cause mortality in men.

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Cardiovascular and all-cause mortality attributable to loneliness in older Swedish men and women

BMC Geriatrics ◽

10.1186/s12877-020-01603-x ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Masuma Novak ◽

Margda Waern ◽

Lena Johansson ◽

Anna Zettergren ◽

Lina Ryden ◽

...

Keyword(s):

Cardiovascular Mortality ◽

Cox Regression ◽

Mortality Data ◽

Men And Women ◽

Face To Face ◽

Risk Of Mortality ◽

Increased Risk ◽

All Cause Mortality ◽

Adjusted Model

Abstract Background This study examined whether loneliness predicts cardiovascular- and all-cause mortality in older men and women. Methods Baseline data from the Gothenburg H70 Birth Cohort Studies, collected during 2000 on 70-year-olds born 1930 and living in Gothenburg were used for analysis (n = 524). Mortality data were analyzed until 2012 through Swedish national registers. Results Perceived loneliness was reported by 17.1% of the men and 30.9% of the women in a face-to-face interview with mental health professional. A total of 142 participants died during the 12-year follow-up period, with 5334 person-years at risk, corresponding to 26.6 deaths/1000 person-years. Cardiovascular disease accounted for 59.2% of all deaths. The cumulative rates/1000 person-years for cardiovascular mortality were 20.8 (men) and 11.5 (women), and for all-cause mortality 33.8 (men) and 20.5 (women), respectively. In Cox regression models, no significant increased risk of mortality was seen for men with loneliness compared to men without loneliness (cardiovascular mortality HR 1.52, 95% CI 0.78–2.96; all-cause HR 1.32, 95% CI 0.77–2.28). Increased risk of cardiovascular mortality was observed in women with loneliness compared to those without (HR 2.25 95% CI 1.14–4.45), and the risk remained significant in a multivariable-adjusted model (HR 2.42 95% CI 1.04–5.65). Conclusions Loneliness was shown to be an independent predictor of cardiovascular mortality in women. We found no evidence to indicate that loneliness was associated with an increased risk of either cardiovascular- or all-cause mortality in men.

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Abstract 248: Assessing the Long Term Association Between Sodium Intake and Mortality

Hypertension ◽

10.1161/hyp.60.suppl_1.a248 ◽

2012 ◽

Vol 60 (suppl_1) ◽

Author(s):

Pamela Singer ◽

Hillel Cohen ◽

Michael Alderman

Keyword(s):

Cardiovascular Mortality ◽

Sodium Intake ◽

Clinical Information ◽

Mortality Data ◽

Inverse Association ◽

Antihypertensive Medications ◽

Hazard Ratios ◽

All Cause Mortality

Background: Studies linking sodium intake and mortality have produced conflicting results, with some showing an inverse or J-shaped relationship. An earlier assessment of this population (mean 3.8 years follow-up) revealed an inverse association of sodium to CVD morbidity and mortality. We now report the association with all-cause and cardiovascular mortality during an average 18.4 years of follow-up. METHODS: Subjects participated in a worksite hypertension program between 1980-1995. Entry criteria were SBP≥140, DBP≥90, or receiving antihypertensive medications. Sodium intake was assessed with 24-hour urine collection. Antihypertensives were discontinued 3-4 weeks prior to collection, and individuals with BP <140/90 after washout were excluded. Mortality data through August 2009 were obtained from NDI and SS Master Death Files. Unadjusted and adjusted hazard ratios (HR) for sex-specific sodium quartiles with all-cause and CV mortality were calculated using Cox regressions. Results: Of 2983 individuals, 66% were male; mean(±sd) age 52.2 (±9.5) years; mean sodium intake 3023 (±1584) mg/day. Mean follow-up time was 18.4 (±5.9) years. There were 878 deaths, including 351 (40%) due to cardiovascular causes. HR and 95% CI (QI vs QIV) for all-cause and CV mortality respectively were 1.24 (1.02, 1.49), p=0.03 and 1.68 (1.20, 2.35), p=0.003 in unadjusted models, and 0.76 (0.61, 0.95), p=0.02, and 0.86 (0.60, 1.25), p=0.44 in adjusted models. Subgroup analysis limited to MI, heart failure and ischemic heart disease also revealed a non-significant direct relationship (p=0.15). Conclusions: We observed a direct association between sodium intake and all-cause mortality, and a similar but non-significant trend with cardiovascular mortality. These are in contrast both to unadjusted models and to an earlier study in the same population. Absence of clinical information after 1998, and the gap between sodium determination and follow-up, limits ability to explain these contrasting findings. Studies that obtain prolonged information on dietary intake and clinical experience over time will be required to better assess long-term associations between sodium intake and health outcomes.

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Performance of the padit score in patients undergoing transvenous lead extraction

European Heart Journal ◽

10.1093/ehjci/ehaa946.0830 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

J.P Dias Ferreira Reis ◽

B Valente ◽

V Ferreira ◽

A Castelo ◽

G Portugal ◽

...

Keyword(s):

Cardiovascular Mortality ◽

Clinical Success ◽

Univariate Analysis ◽

Clinical Success Rate ◽

Lead Extraction ◽

Mortality Data ◽

First Year ◽

All Cause Mortality ◽

Procedural Complications

Abstract Background The PADIT trial identified 5 independent predictors of cardiac implantable electronic device (CIED) infection (prior procedure, age, chronic kidney disease, immunosuppression and type of procedure) and developed a novel infection risk score. Aim To assess whether the PADIT score (PS) could predict CIED reinfection and adverse events in patients (pts) submitted to transvenous lead extraction (LE) using the Pisa Technique (PT) due to CIED infection. Methods We conducted a single-centre prospective study of consecutive procedures (P) of LE using the PT between February 2013 and October 2019. Demographic, clinical, microbiological, device/ procedure related variables, morbidity and mortality data were retrieved during follow-up (FUP). An univariate analysis was performed to evaluate the ability of the PS to predict CIED reinfection (Re), procedural complications (C), all-cause hospital mortality (M), all-cause mortality/ hospitalization during first year of follow-up (MH1) and cardiovascular mortality (CM). Results A total 171 Ps including 159 pts, of which 80.7% (130 pts)were due to CIED infection: 55.1% due to pocket site infection, 18.8% to occult bacteremia with probable CIED infection and 26.1% due to both pocket site and systemic infection, with 44% of pts presenting with valvular/ lead vegetation (mean age - 70.3Y, 77.7% male, mean LVEF of 49.6%). The Rs rate was 93.1% and the clinical success rate was 99.2%. There were no deaths related to the procedure. During a mean FUP of 33 months, 11 pts had to undergo a new P, 5 of them due to pocket reinfection. The mortality rate was 24.2% (37 pts), with 8 pts dying during hospital stay, and 19 pts during the first year post-P. The mean PS was 2.9±2.5 (min- 0, max- 10). A higher PS value was associated with Re (HR - 1,43, CI95% 1.09–1.87, p=0.011), CM (HR - 1,39, CI95% 1.06–1.85, p=0.018) and MH1 (OR - 1,19, CI95% 1.03–1.38, p=0.021). There was no association between the PS and the rate of clinical success of the procedure (2.9% vs 4.5%, p=0.395), procedural complications (2.9% vs 3.3%, p=0.656) and M (4.0% vs 2.8%, p=0.192). Interestingly, a higher PS was not associated with a higher use of an antibacterial envelope during device reimplantation (3.5% vs 2.9%, p=0.371). Conclusion The PADIT score revealed a high predictive power for reinfection, all-cause mortality/ hospitalization during first year of follow-up and cardiovascular mortality in pts submitted to LE using the PT for CIED infection. Funding Acknowledgement Type of funding source: None

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Cardiovascular and all-cause mortality attributable to loneliness in older Swedish men and women

10.21203/rs.2.22585/v1 ◽

2020 ◽

Author(s):

Masuma Novak ◽

Margda waern ◽

Lena Johansson ◽

Anna Zettergren ◽

Lina Ryden ◽

...

Keyword(s):

Cardiovascular Mortality ◽

Cox Regression ◽

Mortality Data ◽

Men And Women ◽

Face To Face ◽

Risk Of Mortality ◽

Increased Risk ◽

All Cause Mortality ◽

Adjusted Model

Abstract Background. This study examined whether loneliness predicts cardiovascular- and all-cause mortality in older men and women. Methods. Baseline data from the Gothenburg H70 Birth Cohort Studies, collected during 2000 on 70-year-olds born 1930 and living in Gothenburg were used for analysis (n=524). Mortality data was analyzed until 2012 through Swedish national registers. Results. Perceived loneliness was reported by 17.1% of the men and 30.9% of the women in a face-to-face interview with mental health professional. A total of 142 participants died during the 12-year follow-up period, with 5 334 person-years at risk, corresponding to 26.6 deaths/1000 person-years. Cardiovascular disease accounted for 59.2% of all deaths. The cumulative rates/1000 person-years for cardiovascular mortality were 20.8 (men) and 11.5 (women), and for all-cause mortality 33.8 (men) and 20.5 (women), respectively. In Cox regression models, no significant increased risk of mortality was seen for men with loneliness compared to men without loneliness (cardiovascular mortality HR 1.52, 95% CI 0.78 - 2.96; all-cause HR 1.32, 95% CI 0.77 - 2.28). Increased risk of cardiovascular mortality was observed in women with loneliness compared to those without (HR 2.25 95% CI 1.14 - 4.45), and the risk remained significant in a multivariable-adjusted model (HR 2.42 95% CI 1.04 - 5.65). Conclusions. Loneliness was shown to be an independent predictor of cardiovascular mortality in women. We found no evidence to indicate that loneliness was associated with an increased risk of either cardiovascular- or all-cause mortality in men.

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Cardiovascular and all-cause mortality attributable to loneliness in older Swedish men and women.

10.21203/rs.2.22585/v3 ◽

2020 ◽

Author(s):

Masuma Novak ◽

Margda waern ◽

Lena Johansson ◽

Anna Zettergren ◽

Lina Ryden ◽

...

Keyword(s):

Cardiovascular Mortality ◽

Cox Regression ◽

Mortality Data ◽

Men And Women ◽

Face To Face ◽

Risk Of Mortality ◽

Increased Risk ◽

All Cause Mortality ◽

Adjusted Model

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Metabolic Syndrome Features and Excess Weight Were Inversely Associated with Nut Consumption after 1-Year Follow-Up in the PREDIMED-Plus Study

Journal of Nutrition ◽

10.1093/jn/nxaa289 ◽

2020 ◽

Vol 150 (12) ◽

pp. 3161-3170

Author(s):

Alicia Julibert ◽

Maria del Mar Bibiloni ◽

Laura Gallardo-Alfaro ◽

Manuela Abbate ◽

Miguel Á Martínez-González ◽

...

Keyword(s):

Blood Pressure ◽

Metabolic Syndrome ◽

Energy Intake ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Virgin Olive Oil ◽

Hdl Cholesterol ◽

Excess Weight ◽

Study Cohort

ABSTRACT Background High nut consumption has been previously associated with decreased prevalence of metabolic syndrome (MetS) regardless of race and dietary patterns. Objectives The aim of this study was to assess whether changes in nut consumption over a 1-y follow-up are associated with changes in features of MetS in a middle-aged and older Spanish population at high cardiovascular disease risk. Methods This prospective 1-y follow-up cohort study, conducted in the framework of the PREvención con DIeta MEDiterránea (PREDIMED)-Plus randomized trial, included 5800 men and women (55–75 y old) with overweight/obesity [BMI (in kg/m2) ≥27 and <40] and MetS. Nut consumption (almonds, pistachios, walnuts, and other nuts) was assessed using data from a validated FFQ. The primary outcome was the change from baseline to 1 y in features of MetS [waist circumference (WC), glycemia, HDL cholesterol, triglyceride (TG), and systolic and diastolic blood pressure] and excess weight (body weight and BMI) according to tertiles of change in nut consumption. Secondary outcomes included changes in dietary and lifestyle characteristics. A generalized linear model was used to compare 1-y changes in features of MetS, weight, dietary intakes, and lifestyle characteristics across tertiles of change in nut consumption. Results As nut consumption increased, between each tertile there was a significant decrease in WC, TG, systolic blood pressure, weight, and BMI (P < 0.05), and a significant increase in HDL cholesterol (only in women, P = 0.044). The interaction effect between time and group was significant for total energy intake (P < 0.001), adherence to the Mediterranean diet (MedDiet) (P < 0.001), and nut consumption (P < 0.001). Across tertiles of increasing nut consumption there was a significant increase in extra virgin olive oil intake and adherence to the MedDiet; change in energy intake, on the other hand, was inversely related to consumption of nuts. Conclusions Features of MetS and excess weight were inversely associated with nut consumption after a 1-y follow-up in the PREDIMED-Plus study cohort. This trial was registered at isrctn.com as ISRCTN89898870.

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Low HbA1c levels and all-cause or cardiovascular mortality among people without diabetes: the US National Health and Nutrition Examination Survey 1999–2015

International Journal of Epidemiology ◽

10.1093/ije/dyaa263 ◽

2020 ◽

Author(s):

Kosuke Inoue ◽

Roch Nianogo ◽

Donatello Telesca ◽

Atsushi Goto ◽

Vahe Khachadourian ◽

...

Keyword(s):

Cardiovascular Mortality ◽

Regression Models ◽

Machine Learning Algorithms ◽

Logistic Regression Models ◽

Health And Nutrition ◽

Increased Risk ◽

The Us ◽

All Cause Mortality ◽

Hba1c Levels

Abstract Objective It is unclear whether relatively low glycated haemoglobin (HbA1c) levels are beneficial or harmful for the long-term health outcomes among people without diabetes. We aimed to investigate the association between low HbA1c levels and mortality among the US general population. Methods This study includes a nationally representative sample of 39 453 US adults from the National Health and Nutrition Examination Surveys 1999–2014, linked to mortality data through 2015. We employed the parametric g-formula with pooled logistic regression models and the ensemble machine learning algorithms to estimate the time-varying risk of all-cause and cardiovascular mortality by HbA1c categories (low, 4.0 to <5.0%; mid-level, 5.0 to <5.7%; prediabetes, 5.7 to <6.5%; and diabetes, ≥6.5% or taking antidiabetic medication), adjusting for 72 potential confounders including demographic characteristics, lifestyle, biomarkers, comorbidities and medications. Results Over a median follow-up of 7.5 years, 5118 (13%) all-cause deaths, and 1116 (3%) cardiovascular deaths were observed. Logistic regression models and machine learning algorithms showed nearly identical predictive performance of death and risk estimates. Compared with mid-level HbA1c, low HbA1c was associated with a 30% (95% CI, 16 to 48) and a 12% (95% CI, 3 to 22) increased risk of all-cause mortality at 5 years and 10 years of follow-up, respectively. We found no evidence that low HbA1c levels were associated with cardiovascular mortality risk. The diabetes group, but not the prediabetes group, also showed an increased risk of all-cause mortality. Conclusions Using the US national database and adjusting for an extensive set of potential confounders with flexible modelling, we found that adults with low HbA1c were at increased risk of all-cause mortality. Further evaluation and careful monitoring of low HbA1c levels need to be considered.

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