Background and Objective: To evaluate the relationship between hemoglobin A1c (HbA1c) levels and angiographic atherosclerotic burden in non-diabetic individuals.

Materials and methods: This retrospective study included adult patients who underwent coronary angiography (CAG) at İzmir Atatürk Training and Research Hospital between 2002 and 2006. All clinical, biochemical, and angiographic data were retrieved from archived hospital records. Individuals with a previous diagnosis of diabetes mellitus or with fasting plasma glucose ≥126 mg/dL were excluded. HbA1c levels, routine biochemical parameters, and classical cardiovascular risk factors were evaluated. The extent and severity of coronary artery disease (CAD) were quantified using the Gensini scoring system, which assigns stenosis-based severity points and multiplies them by segment-specific weighting factors to reflect anatomical importance. Patients were classified according to HbA1c categories and number of involved coronary vessels. Correlations between HbA1c, inflammatory markers, and angiographic severity were analyzed.

Results: Higher HbA1c levels were associated with increased Gensini scores and greater angiographic atherosclerotic burden. Individuals with HbA1c ≥6.0% showed significantly elevated fibrinogen and C-reactive protein levels, suggesting an accompanying low-grade inflammatory process. Although overall group comparisons indicated a significant difference in HbA1c levels, post-hoc analyses did not reveal differences between specific vessel-involvement subgroups. HbA1c demonstrated a modest but meaningful relationship with subclinical coronary atherosclerosis, independent of lipid parameters.

Conclusion: HbA1c may serve as an early, accessible marker of atherosclerotic risk even in individuals without diabetes. This study provides region-specific evidence supporting the integration of HbA1c into cardiovascular risk-stratification strategies for earlier detection and prevention.

January 2026; Vol. 20(1):005.  DOI: https://doi.org/10.55010/imcjms.20.005

*Correspondence: Savas Gokcek, Department of Medical Oncology, Necip Fazıl City Hospital  Kahramanmaraş/Turkey, 46080.Email: gokceksavas35@gmail.com.

© 2026 The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution License(CC BY 4.0).