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Effects of Prediabetes on Subsequent Cardiovascular Disease and Diabetes

In this longitudinal population-based study, 1609 patients were followed between 2002 and 2014 (mean, 10.9 years) to determine whether prediabetes affected risk for cardiovascular disease (CVD) or diabetes mellitus (DM)…

No association was found between prediabetes and the development of cardiovascular disease using models that were adjusted for several factors (including age and gender). However, there was a significant increase in adjusted CVD risk when hypertension was added as a stratifying factor (OR, 2.41). Prediabetes increased risk for DM in models with multivariate adjustment.

Qiu and colleagues attempt to tease out the risks associated with prediabetes defined as impaired fasting glucose and impaired glucose tolerance, particularly in relation to hypertension. Not surprisingly, prediabetes clearly increases the risk for developing diabetes. Interestingly, prediabetes alone was not associated with subsequent cardiovascular disease in patients without hypertension. However, in patients with concurrent hypertension, the risk was significantly elevated, even after robust adjustment for other risk factors.

Whether prediabetes mellitus alone or combined with other disorders means a higher risk for cardiovascular disease (CVD) is still controversial. This study aimed to investigate the association between prediabetes and CVD and diabetes mellitus and to explore whether prediabetes mellitus alone or combined with other syndromes, such as hypertension, could promote CVD risks significantly. Participants with a history of CVD at baseline were excluded from analysis. Multivariate log-binomial regression models were used to adjust possible coexisting factors. Incidence of CVD during follow-up was 10.1%. After adjusting for age, sex, and other factors, the association between prediabetes and CVD was not observed. When hypertension was incorporated in stratifying factors, adjusted CVD risk was elevated significantly (odds ratio, 2.41; 95% confidence interval, 1.25-4.64) in prediabetes mellitus and hypertension combined group, and coexistence of diabetes and hypertension made CVD risk highly significantly increased, reaching 3.43-fold higher than the reference group. Blood glucose level within prediabetic range is significantly associated with elevated risks for diabetes after multivariable adjustment, but only when it is concurrent with other disorders, such as hypertension, it will significantly increase CVD risk.

Practice Pearls:

  • Prediabetes is associated with increased risk for DM and, when accompanied by hypertension, with increased risk for CVD.
  • The diagnosis of type 2 diabetes is a bit artificial and rests on crossing a specific glycemic threshold, most commonly an HbA1c level >6.5%. However, the development of insulin resistance and the subsequent rise in blood glucose stretches over years, with cardiometabolic injury evident even before the actual diagnosis of diabetes is made.
  • This study highlights that the cardiovascular risk associated with glycemic dysregulation starts well before the diagnosis of diabetes, and preventive strategies to improve insulin resistance and modify other cardiac risk factors are critical for primary prevention.

Miaoyan Qiu. Effects of Prediabetes Mellitus Alone or Plus Hypertension on Subsequent Occurrence of Cardiovascular Disease and Diabetes Mellitus, Hypertension – AHA Journals, pub online Jan. 26, 2015, doi: 10.1161/HYPERTENSIONAHA.114.04632.