Risk of Cardiovascular Disease, Death Increased with Prediabetes

This article originally appeared on Practical Cardiology’s sister site, EndocrinologyNetwork.com.

Yuli Huang, PhD

Results from a meta-analysis of more than 100 studies is offering physicians a comprehensive overview of the increased risk of cardiovascular disease and death in patients with prediabetes.

With the prevalence of diabetes expected to rise, results of the analysis suggest patients with a diagnosis of prediabetes were at a 13% increased risk of all-cause mortality and a 15% increased risk of cardiovascular disease over the next decade.

"The prevalence of prediabetes and diabetes is rising rapidly in epidemic proportions, especially in low- and middle-income countries. Early detection and proper treatment can have enormous benefits, but left unaddressed, the life-long complications and health impacts can be devastating," said Yuli Huang, MD, PhD, associate professor of cardiology at Southern Medical University in Shunde, China, in a statement.

The issue of prediabetes is one that has been thrust into the spotlight in recent years. With the prevalence of prediabetes expected to rise swiftly between now and 2030 and the majority of these patients developing type 2 diabetes, prediabetes represents a present and urgent public health issue.

To further understand the current burden of prediabetes, Huang and a team of colleagues designed a meta-analysis to assess associations between prediabetes and risk of all-cause mortality and cardiovascular disease in populations with and without a history of atherosclerotic cardiovascular disease. Using the PubMed, Embase, and Google Scholar databases, investigators searched for studies associated with there the terms “blood glucose” and “cardiovascular disease” or “mortality” from inception through April 25, 2020.

For inclusion in the meta-analysis, studies need to be prospective cohort studies or post hoc analyses of clinical trials in individuals aged 18 years or older and report adjusted risk of associated events. Studies were excluded if enrollment not from the general population or patients with atherosclerotic cardiovascular disease.

In total, the investigators searched returned 31,662 articles. After screening and application of inclusion criteria, a total of 129 studies, involving 10,069,955 individuals, were included in the analysis.

The primary outcomes of the analysis were risk of all-cause mortality and a composite of cardiovascular events in the general population and those with atherosclerotic cardiovascular disease, respectively. Secondary outcomes for the analysis were risk of coronary heart disease and stroke in those with prediabetes versus the with normoglycemia.

Results of the analysis indicated prediabetes was associated with an increased risk of all-cause mortality (Relative risk [RR], 1.13; 95% CI, 1.10-1.17; P <.05), composite cardiovascular disease (RR, 1.15; 95% CI, 1.11-1.18); P <.05), coronary heart disease (RR, 1.16; 95% CI, 1.11-1.21; P=.24), and stroke (RR, 1.14; 95% CI, 1.08-1.20; P <.05) over a median follow-up period of 9.8 years.

When comparing patients with prediabetes to those with normoglycemia, results indicated the absolute risk difference in prediabetes for all-cause mortality (7.36; 95% CI, 9.59-12.51), composite cardiovascular disease (8.75; 95% CI, 6.41-10.49), coronary heart disease (6.59; 95% CI, 4.53-8.65) and stroke (3.68; 95% CI, 2.10-5.26) were all greater in patients with prediabetes when assessing risk per 10,000 person-years.

Among patients with established atherosclerotic cardiovascular disease, prediabetes was associated with an increased risk of all-cause mortality, composite cardiovascular disease, and coronary heart disease in a follow-up period lasting a median of 3.2 years. However, investigators noted there was no difference in stroke among this patient population.

When comparing those with prediabetes versus those with normoglycemia in patients with atherosclerotic cardiovascular disease, prediabetes was associated with an absolute risk increase for all-cause mortality (66.19; 95% CI, 38.60-99.25), composite cardiovascular disease (189.77; 95% CI, 117.97-271.84), coronary heart disease (40.62; 95% CI, 5.42-78.53), and stroke (8.54; 95% CI, 32.43-61.45) when assessing risk per 10,000 person-years. Investigators noted there was no significant heterogeneity found for risk of all outcomes seen among different definitions of prediabetes in those with atherosclerotic cardiovascular disease (P <.10).

“Considering the high prevalence of prediabetes, as well as its strong link to health risks seen in our study, successful intervention in this large population could have a major public health impact,” Huang added.

This study, “Association between prediabetes and risk of all cause mortality and cardiovascular disease: updated meta-analysis,” was published in The British Medical Journal.