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HbA1c-based rather than fasting plasma glucose-based definitions of prediabetes identifies high-risk patients with
Chenxi Song1,2, Sheng Yuan1,2, Kongyong Cui1,2
1Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Insights
Prediabetes, defined by HbA1c levels, increases major adverse cardiovascular events (MACE) risk in patients with coronary intermediate lesions. Early lifestyle intervention may benefit these high-risk individuals.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Prediabetes is a known risk factor for poor outcomes in acute coronary syndrome and revascularization patients.
- The prognostic impact of prediabetes on individuals with coronary intermediate lesions is not well understood.
Purpose of the Study:
- To investigate the impact of prediabetes on prognosis in patients with coronary intermediate lesions.
- To compare the predictive value of different prediabetes definitions for cardiovascular events.
Main Methods:
- 1532 patients with intermediate coronary lesions, not undergoing revascularization, were followed for major adverse cardiovascular events (MACE).
- Patients were categorized based on normal glucose tolerance (NGT), prediabetes, or diabetes using HbA1c or fasting plasma glucose (FPG) criteria.
- Multivariate Cox regression analysis assessed the association between glucose status and MACE risk.
Main Results:
- Prediabetes, defined by the International Expert Committee (IEC) guideline (6.0–6.5% HbA1c), was linked to a significantly higher MACE risk (HR: 1.705) compared to NGT.
- A baseline HbA1c of 6% was identified as the optimal threshold for predicting MACE, showing a linear relationship with risk.
- Fasting plasma glucose-based prediabetes definitions did not show a significant association with patient outcomes.
Conclusions:
- Prediabetes, specifically when defined by HbA1c according to IEC criteria, is associated with increased MACE risk in patients with intermediate coronary lesions.
- HbA1c-based prediabetes identification can help pinpoint high-risk individuals who may benefit from early lifestyle modifications.
Background:
Prediabetes is common and associated with poor prognosis in patients with acute coronary syndrome and those undergoing revascularization. However, the impact of prediabetes on prognosis in patients with coronary intermediate lesions remains unclear. The objective of the current study is to explore the impact of prediabetes and compare the prognostic value of the different definitions of prediabetes in patients with coronary intermediate lesions.
Methods:
A total of 1532 patients attending Fuwai hospital (Beijing, China), with intermediate angiographic coronary lesions, not undergoing revascularization, were followed-up from 2013 to 2021. Patients were classified as normal glucose tolerance (NGT), prediabetes and diabetes according to various definitions based on HbA1c or admission fasting plasma glucose (FPG). The primary endpoint was defined as major adverse cardiovascular events (MACE), the composite endpoint of all-cause death, non-fatal myocardial infarction and repeated revascularization therapy. Multivariate cox regression model was used to explore the association between categories of abnormal glucose category and MACE risk.
Results:
The proportion of patients defined as prediabetes ranged from 3.92% to 47.06% depending on the definition used. A total of 197 MACE occurred during a median follow-up time of 6.1 years. Multivariate cox analysis showed that prediabetes according to the International Expert Committee (IEC) guideline (6.0 ≤ HbA1c < 6.5%) was associated with increased risk of MACE compared with NGT (hazard ratio [HR]: 1.705, 95% confidence interval [CI] 1.143-2.543) and after confounding adjustment (HR: 1.513, 95%CI 1.005-2.277). Consistently, the best cut-off point of glycated haemoglobin (HbA1c) identified based on the Youden's index was also 6%. Restricted cubic spline analysis delineated a linear positive relationship between baseline HbA1c and MACE risk. Globally, FPG or FPG-based definition of prediabetes was not associated with patients' outcome.
Conclusions:
In this cohort of patients with intermediate coronary lesions not undergoing revascularization therapy, prediabetes based on the IEC-HbA1c definition was associated with increased MACE risk compared with NGT, and may assist in identifying high-risk patients who can benefit from early lifestyle intervention.
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