Evaluation of the atherosclerotic burden in hypertensive patients with prediabetes

Area of Science:

• Cardiology
• Endocrinology
• Vascular Medicine

Background:

• Hypertension and prediabetes are significant risk factors for cardiovascular disease.
• Subclinical atherosclerosis in this patient group often goes undetected.
• Early detection of atherosclerotic burden is crucial for risk stratification and management.

Purpose of the Study:

• To evaluate the prevalence of atherosclerotic burden in patients with hypertension and prediabetes.
• To assess subclinical arteriosclerosis using non-invasive vascular imaging techniques.
• To re-stratify cardiovascular risk in this patient cohort.

Main Methods:

• Included patients with hypertension and prediabetes (fasting glucose 100-125 mg/dL and/or HbA1c 5.7-6.4%), excluding those with established cardiovascular disease.
• Measured subclinical arteriosclerosis using ankle-brachial index (ABI) and carotid intima-medial thickness (IMT).
• Defined mild arteriosclerosis as IMT >75th percentile and/or ABI 0.7-0.9; moderate-severe as plaque and/or ABI <0.7.

Main Results:

• Atherosclerotic burden was detected in 66% of the 53 patients.
• Moderate-to-severe arteriosclerosis was found in 41.5% of subjects.
• This led to re-stratification of 41.5% of patients to very high vascular risk, with nearly half of initially moderate-risk patients being reclassified.

Conclusions:

• A significant majority of hypertensive patients with prediabetes exhibit subclinical arteriosclerotic disease.
• Ankle-brachial index and carotid ultrasonography are effective in identifying this burden.
• A substantial proportion of these patients require re-evaluation for very high vascular risk, emphasizing the need for intensified management strategies.