Prediabetes and diabetes independently increase risk of heart disease, CKD, and death: Study
USA: A recent study has found prediabetes and type 2 diabetes (T2D) to be independently associated with an increased risk of CKD, ASCVD, heart failure, and all-cause mortality. For atherosclerotic cardiovascular disease (ASCVD) particularly the risk begins to increase at the lower end of the glycemic spectrum.
The findings, published in the Journal of the American College of Cardiology, suggest the need for careful blood sugar control and monitoring for T2D progression. In addition, prediabetes patients may benefit from ASCVD screening and primary prevention strategies (such as coronary calcium scoring and statin therapy) and screening for albuminuria.
Prediabetes is a prediagnosis of diabetes when a person's blood sugar level is higher than normal but not high enough to be considered diabetes. 470 million worldwide are estimated to have prediabetes by 2030 and 70% of them will eventually develop type 2 diabetes. Guidelines for prediabetes treatment primarily focus on lifestyle management and glycemic control. Few evidence-based cardiovascular and kidney risk-reduction strategies are available in this population.
Considering the above, Michael C. Honigberg, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA, and colleagues sought to characterize cardiovascular and kidney outcomes across the glycemic spectrum.
For this purpose, the researchers using , Cox models tested the association of glycemic exposures (type 2 diabetes [T2D], prediabetes, normoglycemia) with outcomes (atherosclerotic cardiovascular disease [ASCVD], chronic kidney disease [CKD], and heart failure), adjusting for demographic, lifestyle, and cardiometabolic risk factors among participants in the UK Biobank without prevalent type 1 diabetes, cardiovascular disease, or kidney disease.
Among 336,709 people (mean age: 56.3 years, 55.4% female), 13.9% had prediabetes and 3.8% had T2D.
Based on the study, the researchers found the following:
- Over median follow-up of 11.1 years, 13.8% individuals with prediabetes developed ≥1 incident outcome, of whom only 12.4% developed T2D prior to an incident diagnosis.
- Prediabetes and T2D were independently associated with ASCVD (prediabetes: adjusted HR [aHR]: 1.11; T2D: aHR: 1.44), CKD (prediabetes: aHR: 1.08; T2D: aHR: 1.57), and heart failure (prediabetes: aHR: 1.07; T2D: aHR: 1.25).
- Compared with hemoglobin A1c (HbA1c) <5.0%, covariate-adjusted risks increased significantly for ASCVD above HbA1c of 5.4%, CKD above HbA1c of 6.2%, and heart failure above HbA1c of 7.0%.
"Prediabetes and T2D were associated with ASCVD, CKD, and heart failure, but a substantial gradient of risk was observed across HbA1c levels below the threshold for diabetes," wrote the authors. "These findings highlight the need to design risk-reduction strategies across the glycemic spectrum."
Reference:
The study titled, "Cardiovascular and Kidney Outcomes Across the Glycemic Spectrum: Insights From the UK Biobank," is published in the Journal of the American College of Cardiology.
DOI: https://www.jacc.org/doi/10.1016/j.jacc.2021.05.004
