Prediabetes as a Risk Factor for Overall Mortality and Development of CVD
Prediabetes represents a glucose metabolism disorder with a high risk of developing diabetes. According to the expert panel of the American Diabetes Association (ADA), this risk is up to 70%. A recently published meta-analysis confirms that prediabetes is a significant risk factor for mortality and the development of cardiovascular (CV) diseases not only in the general population but also in patients with known CV disease, and its treatment should therefore be part of cardiovascular prevention.
Current Knowledge
The exact definition of prediabetes varies across different professional societies; however, it is generally defined by blood glucose levels above the normal range but below the threshold for diabetes diagnosis. It is estimated that by 2030, more than 470 million people worldwide will have prediabetes.
In a previous meta-analysis by the same authors involving over 1.6 million patients, a correlation was found between prediabetes and an increase in overall mortality and the occurrence of atherosclerotic CV diseases after adjusting for multiple risk factors. This study included the general population. However, the results of later studies on the association of prediabetes with mortality and CV diseases have been inconsistent, and there is also a lack of data for the subgroup of patients with prediabetes and existing CV disease.
Meta-analysis and Monitored Parameters
A recently updated meta-analysis of published clinical studies was conducted to clarify the relationship between prediabetes and overall mortality and the risk of CV diseases in patients with and without a history of CV disease. Suitable prospective cohort studies and post hoc analyses of clinical trials published until April 25, 2020, were included in the meta-analysis. The primary monitored parameter was overall mortality and the risk of developing CV diseases. Secondary monitored parameters included the risk of acute myocardial infarction (AMI) and stroke.
A total of 129 studies with 10,069,955 patients were included.
Results
Increased Mortality and CV Disease Risk in the General Population with Prediabetes
In the general population, prediabetes during a median follow-up of 9.8 years was associated with an increase in overall mortality (relative risk [RR] 1.13; 95% confidence interval [CI] 1.10–1.17), the risk of developing CV diseases (RR 1.15; 95% CI 1.11–1.18), ischemic heart disease (IHD; RR 1.16; 95% CI 1.11–1.21), and stroke (RR 1.14; 95% CI 1.08–1.20). Compared to normoglycemic individuals, the absolute risk difference per 10,000 person-years in the case of prediabetes was 7.36 for overall mortality, 8.75 for CV diseases, 6.59 for IHD, and 3.68 for stroke. In persons with impaired glucose tolerance, the increase in overall mortality and the risk of developing IHD and stroke was higher than in persons with impaired fasting glucose.
Increased Mortality and CV Disease Risk in Persons with Prediabetes and CV Disease
In patients with atherosclerotic CV disease, prediabetes during a median follow-up of 3.2 years was associated with an increase in overall mortality (RR 1.36; 95% CI 1.21–1.54), the risk of developing CV diseases (RR 1.37; 95% CI 1.23–1.53), and IHD (RR 1.15; 95% CI 1.02–1.29), but not stroke (RR 1.05; 95% CI 0.81–1.36). In this population, compared to normoglycemic individuals, the absolute risk difference per 10,000 person-years for patients with prediabetes was 66.19 for overall mortality, 189.77 for the occurrence of CV diseases, 40.62 for IHD, and 8.54 for stroke.
No significant heterogeneity of risk was observed for any of the monitored parameters based on the definition of prediabetes in the population with CV disease (all p > 0.10).
Conclusion
The results of the study indicate that prediabetes is associated with increased overall mortality and an increased risk of developing cardiovascular disease in both the general population and in patients with a history of atherosclerotic CV disease. According to the study authors, the diagnosis and management of prediabetes should thus become an integral part of primary and secondary CV disease prevention.
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Source: Cai X., Zhang Y., Li M. et al. Association between prediabetes and risk of all cause mortality and cardiovascular disease: updated meta-analysis. BMJ 2020; 370: m2297, doi: 10.1136/bmj.m2297.
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