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Prediabetes Defined by First Measured HbA1c Predicts Higher Cardiovascular Risk Compared With HbA1c in the Diabetes
Sam Kafai Yahyavi1, Ole Snorgaard2, Filip Krag Knop3,4,5,6
1Group of Skeletal, Mineral, and Gonadal Endocrinology, Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark sam.kafai.yahyavi.01@regionh.dk.
Insights
Individuals with prediabetes face increased risks of major adverse cardiovascular events (MACE) and mortality. Higher HbA1c levels within the prediabetes range correlate with greater cardiovascular risk, emphasizing proactive management.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Prediabetes is a growing public health concern, characterized by elevated blood glucose levels below the diagnostic threshold for type 2 diabetes.
- Understanding cardiovascular risk in prediabetes is crucial for timely intervention and prevention strategies.
Purpose of the Study:
- To evaluate the association between first-time measured HbA1c levels within the prediabetes range and the risk of major adverse cardiovascular events (MACE), all-cause mortality, and medication initiation.
- To identify specific HbA1c thresholds in prediabetes associated with heightened cardiovascular risk.
Main Methods:
- A registry-based cohort study of 84,678 Danish patients with a first HbA1c between 40-51 mmol/mol (5.8-6.8%) was conducted.
- Cox regression models and cumulative incidence analyses were used to assess MACE, mortality, and medication initiation over a 12-month follow-up period.
Main Results:
- The risk of MACE and all-cause mortality increased progressively with HbA1c levels up to 47 mmol/mol (6.5%).
- Patients with HbA1c 46-47 mmol/mol (6.4-6.5%) exhibited a significantly higher risk of MACE compared to those with HbA1c 40-41 mmol/mol (5.8-5.9%).
- Medication initiation rates varied across HbA1c strata, being lower in the 46-47 mmol/mol group compared to the 48-49 mmol/mol group.
Conclusions:
- The highest risk for MACE and mortality in the screened population occurred at HbA1c levels just below the diabetes diagnostic threshold.
- These findings underscore the importance of managing cardiovascular risk factors in individuals diagnosed with prediabetes.
Objective:
To assess the risk of major adverse cardiovascular events (MACE), all-cause mortality, and initiation of medical treatment in subjects with prediabetes according to first-time measured HbA1c.
Research Design And Methods:
Through registry databases, we identified 326,305 Danish patients with a first HbA1c between 40 and 51 mmol/mol (5.8-6.8%) from 2011 to 2017. After exclusion of patients with prior disease, 84,678 patients were followed 12 months after first HbA1c measurement. Cox regression models were used to estimate hazard ratios (HRs) of MACE and standardized absolute risks. Cumulative incidences were used to analyze initiation of glucose-lowering, antihypertensive, cholesterol-lowering, and antithrombotic medication.
Results:
The 12-month risk of MACE and all-cause mortality increased gradually with increasing HbA1c until 47 mmol/mol (6.5%). In comparisons of subjects with HbA1c 40-41 mmol/mol (5.8-5.9%), subjects with HbA1c 46-47 mmol/mol (6.4-6.5%) had a 0.79% (95% CI 0.33-1.24) higher standardized absolute risk and an HR of 2.21 (95% CI 1.67-2.92) of MACE. Patients with HbA1c 48-49 mmol/mol (6.5-6.6%) had a 0.09% (95% CI -0.35 to 0.52) lower absolute risk and an HR of 1.33 (95% CI 0.87-2.05) of MACE. Initiation of medication was significantly lower among patients with HbA1c of 46-47 mmol/mol (6.4-6.5%) than among patients with HbA1c of 48-49 mmol/mol (6.5-6.6%).
Conclusions:
In the Danish population screened for diabetes with HbA1c, the highest risk of MACE and all-cause mortality was found in subjects with HbA1c just below the diagnostic threshold for diabetes. Our results highlight the need for increased focus on the treatment of cardiovascular risk factors for subjects with prediabetes.
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