Cardiovascular disease (CVD) or rather heart disease is the number one cause of death in India, and if you have diabetes coupled with obesity then your risk is even higher – atleast 50-60% . While high blood pressure , weight and cholesterol are well-known risk factors, there's another silent indicator that often goes unnoticed: HbA1c levels. This simple blood test, commonly used to monitor diabetes, can also serve as an early warning sign for cardiovascular risk, especially when levels rise above 6.5%, it is not just about sugar, but a wake-up call for your heart. The Concept of Q-risk To understand the burden of heart disease ( cardiovascular disease ) , tools like Q-risk play an important role. Q-Risk is a tool doctors use to calculate how likely you are to have a heart attack or stroke in the next 10 years. It’s like a health forecast, based on your personal information. It considers factors such as age, gender, ethnicity, diabetes, blood pressure, cholesterol, smoking status, and family history. Once all this is entered, Q-Risk gives a score—like a percentage. For example, if your score is 15%, that means there’s a 15 in 100 chance you could have a heart-related issue in the next decade. Why It’s Useful If your score is high, your doctor might suggest lifestyle changes, medications, or regular check-ups to lower your risk. If your score is low, it’s a good sign—but it’s still important to stay healthy. Think of Q-Risk as a personal heart health check-up that helps you and your doctor make smart choices early—before problems start. The Hidden Link: HbA1c and Cardiovascular Risk HbA1c, or glycated haemoglobin or blood glucose , reflects average blood sugar levels over the past two to three months. While it's primarily used to diagnose and monitor diabetes and weight, recent studies have shown that elevated HbA1c levels, even in individuals without diabetes, are associated with an increased Qrisk of cardiovascular events1. This makes HbA1c a valuable marker for identifying individuals at risk, even before other symptoms appear. Understanding the Elevated Cardiovascular Risk in India South Asians, including Indians, are genetically predisposed to higher cardiovascular Qrisk,2 and this event is further amplified by lifestyle changes and rising obesity rates in urban areas. Type 2 diabetes appears to increase the risk of cardiovascular disease in Asian Indian individuals further by 3–4 times as compared to their white counterparts, even after adjusting for sex, age, smoking status, hypertension, and obesity3 and only few people with type 2 diabetes get access to medication which has proven cardiovascular benefits.4 This heightened risk underscores the importance of regular monitoring and early intervention strategies tailored to this population. According to the Registrar General of India, the World Health Organisation, and the Global Burden of Disease Study, cardiovascular diseases are the leading causes of death and disability in India. Age-adjusted mortality from these conditions has increased by 31% over the past 25 years. Hypertension is identified as the most significant risk factor for CVD in India, and better hypertension control could prevent 400,000 to 500,000 premature deaths annually5. This combination of genetic susceptibility and changing lifestyle patterns underscores the need for regular monitoring, early intervention, and preventive strategies tailored to this population. Treating Early : Protecting the Heart Health with Newer Solutions Today Given the current trend in rising cardiovascular diseases, early intervention is becoming critical. Timely action helps individuals manage HbA1c effectively, lowering the risk of long-term complications. This involves a combination of regular monitoring, maintaining optimal body weight, other preventive strategies, and evidence-based therapies. Semaglutide belonging to a class of GLP-1 receptor agonist is a molecule which is available both in pill and recently launched injection form for weight management . Oral semaglutide has been available in India since 2022 with experience of at least million patients worldwide. A recent global study called the SOUL trial found that oral semaglutide—a diabetes medicine available in India since 2022—not only helps control blood sugar but also protects the heart. For people with type 2 diabetes and high risk of heart problems, the study showed: A 14% lower chance of serious heart issues like heart attacks, strokes, or heart-related death compared to those who didn’t take the medicine.Among Asian participants, the benefit was even greater—with a 27% reduction in heart-related risks.When introduced early and combined with lifestyle measures such as nutrition, exercise, and routine health checks, these interventions can deliver lasting protection for both heart and metabolic health. This means we now have the only oral pill in diabetes having this heart benefit along with weight and HbA1c benefit . A Call to Action By recognising the connection between HbA1c levels and their implication as an indicator of cardiovascular risk, the rising tide of heart disease in India can be slowed down. Implementing early interventions, including lifestyle modifications and appropriate therapies should become a standard part of healthcare practice, especially among those at higher risk. Acting early prevents complications and improves long-term health outcomes, offering a pathway to reducing the country’s growing burden of cardiovascular disease.
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