ACC.21 Study Underlines Serious Risk Prediabetes Poses to Cardiovascular Health

Adrian Michel, MD

New research released ahead of the American College of Cardiology’s 70th Scientific Sessions (ACC.21) is raising a red flag related to management of patients with prediabetes.

While often overshadowed due to the growing impact of diabetes, the retrospective chart review by Beaumont Health investigators underlines the importance of not overlooking prediabetes and its impact on risk for cardiovascular disease.

"In general, we tend to treat prediabetes as no big deal. But we found that prediabetes itself can significantly boost someone's chance of having a major cardiovascular event, even if they never progress to having diabetes," said Adrian Michel, MD, internal medicine resident at Beaumont Hospital-Royal Oak, in a statement. "Instead of preventing diabetes, we need to shift focus and prevent prediabetes."

Few, if any, conditions in history have established a foothold in our cultural landscape as the diabetes epidemic has in recent decades. Despite the impact of full-blown diabetes, current research is insufficient in describing the risks and impact of prediabetes on cardiovascular and overall health.

With this in mind, Michel and a team of colleagues from Beaumont Health designed the current study as a retrospective chart review, which they claim is one of the largest to date, with the goal of estimating the additional risk of cardiovascular disease that accompanies prediabetes. Using data collected within the Beaumont Health System from 2006-2020, investigators identified 25,829 patients for inclusion in their analysis. Of note, these patients were classified according to glycemic status as having prediabetes (n=12,691) or study controls (n=13,138).

For inclusion in the study, patients needed to be between 18-104 years of age and have HbA1c measurements at least 5 years apart during the study period. Investigators planned to use Chi-square analysis to compare rate of major adverse cardiovascular events between the study groups and incidence of major adverse cardiovascular events were identified through use of ICD codes. For the purpose of analysis, prediabetes was defined as an A1c between 5.7-6.4%.

Upon analysis, results indicated major adverse cardiovascular events occurred among 18% of pattens in the prediabetes group and 11% in patients within the control group over a median of 5 years follow-up. Compared against each other, prediabetes was associated with nearly twice the risk of experiencing a major adverse cardiovascular event ([17.07; 95% CI, 17.3-18.63] and [11.01; 95% CI, 10.48-11.55]; P <.0001).

In the aforementioned statement, investigators pointed out results observed during the analyses remained significant even after adjustment for factors including age, gender, BMI, blood pressure, cholesterol, sleep apnea, smoking status, and peripheral artery disease.

"As clinicians, we need to spend more time educating our patients about the risk of elevated blood sugar levels and what it means for their heart health and consider starting medication much earlier or more aggressively, and advising on risk factor modification, including advice on exercise and adopting a healthy diet,” Michel said.

This study, “Prediabetes Associated with An Increase in Major Adverse Cardiovascular Events,” was presented at ACC.21.