Association Between Hemoglobin A1c and Cerebral Microbleeds in Community-based Stroke-free Individuals: a Cross-sectional Study

Background: The association between hemoglobin A1c (HbA1c) and cerebral microbleeds (CMBs) remains unclear. We aimed to investigate the association between HbA1c and CMBs in community-based individuals without stroke or transient ischemic attack and whether it differs between individuals with and without diabetes mellitus.Methods: This cross-sectional study recruited individuals from a community in Beijing, China from January 2015 to September 2019. All individuals completed the questionnaires and underwent blood tests and brain magnetic resonance imaging. A susceptibility-weighted imaging sequence was used to detect CMBs, defined as small, round, and low-signal lesions with a diameter <10 mm. The association between HbA1c and CMBs was analyzed using a multivariable logistic regression model adjusted for demographics, medical history, and blood sample test results. Subgroup analyses stratified by history of diabetes mellitus were performed.Results: CMBs were detected in 119 (21.88%) individuals. HbA1c was independently associated with CMBs after adjustment (adjusted odds ratio [OR],1.51; 95% confidence interval [CI], 1.03–2.22). In 87 patients with diabetes mellitus, the multivariable logistic analysis showed that HbA1c was significantly associated with CMBs (adjusted OR, 1.67; 95% CI, 1.04–2.69), whereas in individuals without diabetes mellitus, no significant association was observed between HbA1c and CMBs (adjusted OR, 1.07; 95% CI, 0.50–2.30).Conclusions: HbA1c is associated with CMBs in participants without stroke or transient ischemic attack, particularly in patients with diabetes mellitus. This finding suggests that the status of glycemic control warrants attention for the prevention of CMBs. It would be beneficial to manage HbA1c strictly to control the risk of CMBs, especially in patients with diabetes mellitus.