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Fit Bengaluru executive suffers heart attack although his tests were normal 6 months ago: What did he miss?
Why some people with comorbidities need two tests a year. Skipping can put your heart at risk
HbA1c, or glycated haemoglobin, reflects the average blood glucose levels over the past two to three months.
When a 48-year-old senior executive in Bengaluru had a heart attack despite being a regular exerciser with normal markers in blood, lipid and sugar tests just about six months ago, I repeated the routine blood sugar and HbA1c (average blood sugar count of three months) tests. Particularly so because he had a family history. His regular blood sugar count was 400 and his HbA1c reading was 13.5%. During this period, he had persistent work stress, which was accelerated by a new deadline-driven project. It had raised his cortisol levels alarmingly, which in turn had spiked his blood sugar levels.
What people with family history or any other risk factor do not know is that BP and sugar spikes can come in short intervals. Which is why, some people need two tests a year, or at six-month gaps, to better regulate their parameters and avoid a heart attack. Research also shows that major life events within a three-month period are associated with accelerated increases in A1c.
Understanding HbA1c and its importance in heart health
HbA1c, or glycated haemoglobin, reflects the average blood glucose levels over the past two to three months. Unlike daily glucose checks, it provides a broader picture of how well blood sugar is being controlled over time.
Consistently elevated HbA1c levels indicate prolonged exposure to high glucose, which can damage blood vessels and organs. High glucose, even for a short time, acts like sandpaper on the lining of the heart vessels, causing inflammation and allowing plaque to build up (atherosclerosis).
Research shows that elevated HbA1c specifically makes such plaques more vulnerable to rupture, raising the risk of heart attacks. A 1% increase in HbA1c is associated with an approximately 18% increase in cardiovascular events, such as myocardial infarction (heart attack) and stroke. Studies suggest that an HbA1c level higher than 6% is associated with higher risks of cardiovascular disease and mortality in both men and women. Those with uncontrolled diabetes (HbA1c higher than 7%) show a significantly higher prevalence of heart attack.
Why twice a year is the minimum
Healthcare guidelines recommend HbA1c testing at least twice a year for individuals with stable blood sugar control. This frequency ensures that any gradual changes are detected before they become severe. For those with fluctuating glucose levels or recent changes in treatment, more frequent testing may be necessary.
Testing every six months strikes a balance between practicality and effectiveness. Since HbA1c reflects a three-month average, biannual testing provides overlapping insights, ensuring that no significant period of poor control goes unnoticed.
Early detection leads to prevention
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Regular HbA1c testing allows healthcare providers to adjust treatment plans, including diet, exercise, and medication. Even small improvements in HbA1c can significantly lower the risk of cardiovascular complications. Early detection of rising levels enables proactive steps rather than reactive treatment after damage has occurred.
A simple test with lifesaving impact
The HbA1c test is simple, non-fasting and widely accessible. Despite its simplicity, it offers powerful insights into long-term health risks. By committing to testing at least twice a year, you can take control of your heart health.
(Dr Shetty is lead cardiologist and medical director, Sparsh Hospital, Bengaluru)
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