This article is more than 5 years old. Information may no longer be current.
Prediabetes increases CVD, all-cause mortality risk
Click Here to Manage Email Alerts
The risk for cardiovascular disease and all-cause mortality is increased among people with a fasting glucose concentration of at least 5.6 mmol/L or an HbA1c of at least 39 mmol/mol, study data show.
Yunzhao Hu, MD, PhD, professor in the department of cardiology at First People’s Hospital of Shunde in Foshan, China, and colleagues evaluated 53 prospective cohort studies to determine the associations between different definitions of prediabetes and the risks for CVD and all-cause mortality.
Prediabetes was variously defined as fasting glucose of 5.6 mmol/L to 6.9 mmol/L (American Diabetes Association definition for impaired fasting glucose), fasting glucose of 6.1 mmol/L to 6.9 mmol/L (WHO definition for IFG), 2-hour plasma glucose concentration of 7.8 mmol/L to 11 mmol/L during an oral glucose tolerance test (impaired glucose tolerance), HbA1c of 5.7% to 6.4% (ADA criteria) and HbA1c 6% to 6.4% (National Institute for Health and Care Excellence [NICE] guideline). Follow-up for the studies was a median 9.5 years.
Overall, data from 25 studies were used in determining the relationship between prediabetes and risk for all-cause mortality. The risk for all-cause mortality was increased when prediabetes was based on the ADA definition for IFG (RR = 1.13; 95% CI, 1.05-1.25), the WHO definition for IFG (RR = 1.13; 95% CI, 1.05-1.21) or IGT (RR = 1.32; 95% CI, 1.23-1.4). Participants with IGT had a higher risk for all-cause mortality compared with participants in groups according to other definitions of prediabetes (P < .001).
The association between the risk for composite CVD and prediabetes was based on data from 35 studies. The risk for increased composite CV events was increased when prediabetes was defined as the ADA definition for IFG (RR = 1.13; 95% CI, 1.05-1.21), the WHO definition for IFG (RR = 1.26; 95% CI, 1.12-1.41), IGT (RR = 1.3; 95% CI, 1.19-1.42), HbA1c 38.8 mmol/mol to 46.4 mmol/mol (RR = 1.21; 95% CI, 1.01-1.44) or HbA1c 42.11 mmol/mol to 46.4 mmol/mol (RR = 1.25; 95% CI, 1.01-1.55).
The relationship between prediabetes and the risk for coronary heart disease was based on data from 24 studies. CHD risk was increased when prediabetes was defined using the ADA criteria for IFG (RR = 1.1; 95% CI, 1.04-1.16), WHO criteria for IFG (RR = 1.18; 95% CI, 1.08-1.28), IGT (RR = 1.2; 95% CI, 1-1.44), HbA1c 39 mmol/mol to 47 mmol/mol (RR = 1.15; 95% CI, 1.01-1.33) or HbA1c 42 mmol/mol to 47 mmol/mol (RR = 1.28; 95% CI, 1.03-1.59).
The risk for stroke was increased when prediabetes was defined by ADA criteria for IFG (RR = 1.06; 95% CI, 1.01-1.11), WHO criteria for IFG (RR = 1.17; 95% CI, 1.09-1.25) and IGT (RR = 1.2; 95% CI, 1-1.45) after multivariate adjustment.
“The risk increased in people with fasting glucose levels as low as 100 mg/dL and with HbA1c of 5.7%,” Hu told Endocrine Today. “So we believe people with prediabetes should [be followed up clinically] and keep a healthy lifestyle. We need to develop models for risk stratification in people with prediabetes, and we will select higher-risk people with prediabetes to evaluate whether drug treatment can prevent CVDs in them.” – by Amber Cox
For more information:
Yunzhao Hu, MD, PhD, can be reached at huyunzhao4406@163.com.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
Back to Top
Robert A. Gabbay
This is an interesting study. The authors analyzed a large amount of data by pulling together these 25 studies to look at the relationship between prediabetes and all-cause mortality and cardiovascular mortality. In some sense, the results are not a big surprise for those of us who follow this area. We know that people with prediabetes are at increased risk for CVD. Before we used the term “prediabetes,” we would talk about metabolic syndrome. There is overlap; people who have metabolic syndrome often have prediabetes, and most people who have prediabetes have metabolic syndrome. It has long been known that people with metabolic syndrome have increased risk for CVD and mortality, so this extends that. That said, one of the big challenges we face is that many people who have prediabetes are unaware that they have it because they have not been screened and diagnosed. So, the value of these kinds of studies is that they suggest the need to be screened; also with coverage now imminent for diabetes prevention, this becomes an even greater rationale for individuals with prediabetes to make the changes in their health to reduce CV mortality.
Disclosure: Gabbay reports no relevant financial disclosures
Click Here to Manage Email Alerts