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Risk for major adverse CV events modest with prediabetes
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SAN DIEGO — Adults with prediabetes have a modestly increased risk for major adverse cardiovascular events, while younger patients with recent-onset or longer duration of diabetes have a higher risk for events, according to a speaker here.
“In terms of risk of vascular disease, it has been well noted that the clock starts ticking prior to the development of diabetes,” Gillian L. Booth, PhD, MSc, associate professor at the Institute of Health Policy, Management and Evaluation at the University of Toronto, said during a presentation. “In a recent meta-analysis, impaired fasting glucose based on either [American Diabetes Association] criteria or the WHO criteria was associated with a small but significantly increased incidence of major adverse CV events. [However], many studies lack sufficient power to look at subpopulations that may be more susceptible to the effects of prediabetes.”
Booth and colleagues evaluated data from the CANHEART cohort of 1,415,241 adults aged 40 years and older in Ontario who were free of CV disease. The researchers sought to determine whether prediabetes is an independent risk factor for major CV events relative to normal blood glucose levels; whether the association is consistent across middle-aged and older adults; whether the association is independent of other conditions associated with insulin resistance; and whether the development of diabetes is a mediator of the association.
Participants were enrolled on Jan. 1, 2008, and followed until Dec. 31, 2012, for major adverse CV events including nonfatal myocardial infarction, nonfatal stroke or CVD death.
At baseline, 111,826 participants had prediabetes, 261,193 had diabetes and the rest had normal glucose status. Overall, 63,059 major adverse CV events and more than 96,000 deaths occurred during follow-up.
Risk for major adverse CV events was significantly increased in participants with prediabetes aged younger than 65 years compared with participants with normoglycemia (HR = 1.1; 95% CI, 1.04-1.17). However, risk was not increased in participants with prediabetes aged 65 years and older after adjustment for age, sex and CVD risk factors. After the researchers accounted for development of diabetes, the increased risk for major adverse CV events persisted in participants aged younger than 65 years (HR = 1.16; 95% CI, 1.07-1.1), whereas risk was not increased among participants aged 65 years and older. Among the younger participants, risk for major adverse CV events was weaker with prediabetes compared with recent-onset diabetes (diabetes < 2 years vs. normoglycemia: HR = 1.41; 95% CI, 1.29-1.53) and diabetes of longer duration (diabetes > 15 years vs. normoglycemia: HR = 4.02; 95% CI, 3.74-4.33).
“Prediabetes was associated with a modestly increased incidence of [major adverse CV events] in middle-aged adults,” Booth said. “The association was greater among those with prediabetes based on a higher threshold for impaired fasting glucose, and in younger groups it was independent of a transition from prediabetes to diabetes during follow-up. Prediabetes contributed to the risk of [major adverse CV events] among individuals without other clinical features of insulin resistance such as hypertension and dyslipidemia, but added little to no additional risk to individuals who had those features.” – by Amber Cox
Reference:
Booth GL, et al. 86-OR. Presented at: American Diabetes Association 77th Scientific Sessions; June 9-13, 2017; San Diego.
Disclosures: Booth reports no relevant financial disclosures.