New Strategies Needed to Address Cardiovascular Risk Trajectory Associated with Prediabetes

An analysis of data from the UK Biobank study presented at the American College of Cardiology’s 70th Annual Scientific Session (ACC.21) is outlining the risk of adverse cardiovascular and renal outcomes across the glycemic spectrum of patients within the database.

Conducted by investigators from Massachusetts General Hospital and Harvard, results of the study portray a substantial gradient of risk across HbA1c levels, not only among patients with diabetes, but also in the prediabetic range.

“Prediabetes is a clinical entity, has intrinsic cardiovascular and kidney risk, and new strategies are required to bend that risk trajectory,” said Muthiah Vaduganathan, MD, MPH, a cardiologist at Brigham and Women’s Hospital, in an interview.

With an interest in describing the cardiovascular and renal risk associated with HbA1c levels, among patients with diabetes and prediabetes, Vaduganathan and colleagues designed the study to assess these associations in UK Biobank participants without prevalent type 1 diabetes, atherosclerotic cardiovascular disease (ASCVD), heart failure, or chronic kidney disease. Using these criteria, 439,440 adult patients were identified for inclusion.

This cohort had a mean age of 56.3 years, 55.8% were female, 14.2% (n=62,294) had prediabetes, and 3.9% (n=16,690) had type 2 diabetes. For the purpose of analysis, exposures for the study included prediabetes and type 2 diabetes versus those without diabetes. Outcomes of interest included incidence of ASCVD, heart failure, and chronic kidney disease.

During a follow-up period lasting a median of 11.1 years, at least 1 outcome occurred among 7.9% (n=28,530) of adults without diabetes, 14.0% (n=8729) with prediabetes, and 24.35% (n=4137) with diabetes. In multivariable-adjusted models, type 2 diabetes was associated with an increased risk of ASCVD, heart failure, and chronic kidney disease. Additionally, prediabetes was associated independently with all outcomes except stroke, but investigators noted a substantial gradient of risk was observed across HbA1c levels in the prediabetic range.

As part of our coverage of ACC.21, Practical Cardiology reached out to Vaduganathan and that conversation is the subject of this ACC.21 House Call.

This study, “Cardiovascular and Renal Outcomes Across the Glycemic Spectrum: Insight from the UK Biobank,” was presented at ACC.21 and simultaneously published in the Journal of the American College of Cardiology.