Prediabetes and 20-year cardiovascular disease incidence: the ATTICA cohort study (2002-2022)

Individuals with prediabetes carry an increased cardiometabolic burden; however, the extent to which prediabetes contributes to cardiovascular disease (CVD) risk remains uncertain. We aimed to investigate the 20-year incidence of CVD among individuals with impaired fasting glucose (IFG) and to determine whether IFG independently predicts CVD events.

This study is based on the 20-year follow-up data (2002-2022) of the ATTICA study, a population-based prospective cohort of rural population living in the greater Athens area, Greece. A total of 1,796 adults free of CVD and T2D at baseline were included, of whom 333 (18.5%) had impaired fasting glucose (IFG) and 1,463 (81.5%) had normal fasting glucose (NFG). Incident fatal or non-fatal CVD events were recorded during follow-up. Cox proportional hazards models were applied to evaluate the association between IFG and CVD.

Over the 20-year follow-up, all participants with IFG progressed to T2D, compared with 13.5% of those with NFG (p < 0.001). The incidence of CVD was higher in the IFG group (40.2%) than in the NFG group (30.2%, p=0.001). In multivariable models, IFG independently predicted CVD events (HR=1.21, 95%CI [1.01, 1.48] p=0.038). Landmark analyses demonstrated that earlier onset of T2D (before 10 years) was associated with a higher subsequent risk of CVD (adjusted OR 2.46, p < 0.05).

Prediabetes defined by IFG is an independent predictor of CVD, beyond traditional cardiometabolic risk factors. Moreover, earlier T2D onset markedly increases CVD risk, highlighting the need for timely screening and preventive strategies in individuals with prediabetes.