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Prediabetes as a risk factor for major adverse cardiovascular events
Ramy Mando1, Muhammad Waheed2, Adrian Michel3
1Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, Royal Oak, MI, USA.
Introduction:
Type II diabetes mellitus (DM) is a proinflammatory process and a known risk factor for major adverse cardiac events (MACE). The same inflammatory markers may be present in prediabetes (pDM); however, the relationship between pDM by HbA1c and MACE is not well studied. We sought to see if pDM increases one's risk for MACE.
Methods:
We retrospectively studied patients at Beaumont Health, Michigan between 2006 and 2020. We divided patients into groups (G1-G5) based on haemoglobin A1c (HbA1c) trends over the study period as follows: G1: pDM patients who remained pDM; G2: pDM who progressed into DM; G3: pDM who normalized their HbA1c; G4: patients who maintained a normal HbA1c; and G5: patients with HbA1c persistently in the DM range. We compared MACE between the groups by univariate and multivariate regression analyses.
Results:
A total of 119,271 patients were included in the study (G1: N = 13,520, G2: N = 6314, G3: N = 1585, G4: N = 15,018, G5: N = 82,834). Pairwise comparison revealed a statistically significant increase in the odds of MACE in all groups compared to those with normal HbA1c values (G4; p < .001). After adjusting for baseline characteristics, multivariate regression revealed elevated odds of MACE in patients with persistent pDM (G1; aOR = 1.087, p = .002) and diabetes (G2/G5; aOR = 1.25 and aOR = 1.18, p < .001) compared to individuals with normal HbA1c values.
Conclusion:
Prediabetes is a risk factor for MACE. Normalization of HbA1c values appears to decrease the adjusted risk for MACE and should be the goal in patients with pDM.KEY MESSAGESPatients with prediabetes (pDM) are at increased risk for major cardiovascular events.Normalization of HbA1c in pDM patients may have a clinically significant benefit, in terms of lowering the MACE risk.Prediabetes patients who progress into diabetes mellitus may represent a particularly high-risk group.
Insights
Prediabetes (pDM) significantly increases the risk of major adverse cardiac events (MACE). Normalizing hemoglobin A1c (HbA1c) levels in prediabetes patients can reduce this cardiovascular risk.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Type II diabetes mellitus (DM) is a known risk factor for major adverse cardiac events (MACE) due to its proinflammatory nature.
- Inflammatory markers associated with DM may also be present in prediabetes (pDM), but the link between pDM and MACE is not well-established.
Purpose of the Study:
- To investigate whether prediabetes (pDM), identified by hemoglobin A1c (HbA1c) levels, increases the risk of major adverse cardiac events (MACE).
Main Methods:
- A retrospective study of 119,271 patients from 2006-2020, categorized by HbA1c trends into five groups: persistent pDM, pDM progressing to DM, pDM normalizing HbA1c, normal HbA1c, and persistent DM.
- Comparative analysis of MACE incidence across these groups using univariate and multivariate regression, adjusting for baseline characteristics.
Main Results:
- All patient groups, including those with persistent pDM and progressing to DM, showed a statistically significant increase in MACE odds compared to individuals with normal HbA1c.
- Multivariate analysis confirmed elevated MACE odds in persistent pDM (aOR=1.087) and diabetes groups (aOR=1.25-1.18) compared to the normal HbA1c group.
Conclusions:
- Prediabetes (pDM) is identified as an independent risk factor for major adverse cardiac events (MACE).
- Normalization of HbA1c in pDM patients is associated with a reduced adjusted risk for MACE, highlighting it as a critical therapeutic goal.
- Patients with pDM who progress to diabetes mellitus represent a particularly high-risk population for MACE.
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