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AACE: CAD Risk for Pre-Diabetes Similar to Diabetes

Prediabetes patients show similar heart risks as those with diabetes….

Harith Al-Shuwaykh, MD, a resident in internal medicine at Crittenton Hospital Medical Center, Wayne State University, Detroit, stated that, in the study, about 36% of patients with impaired fasting glucose had coronary artery disease compared with 42% of patients with diabetes and 21% of patients with normal blood glucose.

Those findings were based on a review of 86 patients who underwent elective percutaneous coronary intervention. Likewise 37% of patients with impaired fasting glucose had hyperlipidemia compared with 38% of patients with diabetes and 24% of patients with normal blood glucose.

The results indicate that early intervention among prediabetics is warranted. He added that, "It is recommended to identify and treat impaired fasting glucose patients early since impaired fasting glucose patients’ distribution in coronary artery disease is comparable to diabetes mellitus." He noted that both impaired fasting glucose patients and diabetes patients had nearly double the distribution of hypertension and high cholesterol when compared with normal fasting glucose patients.

He said his results also suggest a need to screen patients with a family history of coronary artery diseases for impaired fasting glucose and diabetes since 40% of the patients with impaired fasting glucose has a family history of heart disease and 33% of those with diabetes had a family history of heart disease.

"In our study we tried to find the impact and contribution of impaired fasting glucose as a risk factor for coronary artery disease in a population of patients who already have coronary disease," Al-Shuwaykh explained. "We found that a large percentage of these people do have diabetes but the people with impaired glucose levels have similar risk profiles."

The chart review revealed that 19 of the individuals had normal fasting glucose levels, that is fasting blood glues below 100 mg/dL; 30 patients had impaired fasting blood glucose levels (100-125 mg/dL) and 37 patients were diabetic with fasting blood glucose levels above 125 mg/dL.

"What the study showed was that even though the glucose levels were not at the level of diabetes there was an impact on the body in regards to hypertension and lipids, etc. It shows there, indeed, is an abnormality there. The fasting glucose below 100 mg/dL is normal. Fasting glucose above 126 mg/dL is diabetes. But that in between area is significant and that is what this study shows."

Al-Shuwaykh said, "Our study emphasizes the role of the primary care physician and the endocrinologist in how to deal with this problem. We have to intervene early and create an educational program to prevent impaired fasting glucose and if it is diagnosed we should act on it promptly."

"Usually what we tell the patient is to exercise, diet, lose weight and most of those patients will try but it is really difficult for them and a lot of them will ignore the problem and they come later with coronary artery disease. So our recommendation is to treat those patients and to follow with exercise for a goal of taking them out of treatment when they really commit to a diet and exercise program."

"I think that in the case of prediabetes we should consider intervening pharmacologically because there are abnormalities there that we could treat. It would be off-label but I think it would be important to look at that and get more studies and study this further," he said.

Practice Pearls:

  • Note that this in this small, single-center study of patients who underwent elective PCI, diabetes or impaired fasting glucose was associated with a higher risk of evident coronary artery disease.
  • Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

American Association of Clinical Endocrinologists Source reference: Al-Shuwaykh H, et al "Impaired fasting glucose as a risk Factor for coronary artery disease compared to diabetes mellitus and normal blood sugar in association with other CAD risks" AACE 2013; Abstract 257.