Should We Shift Focus to Preventing Prediabetes?
A WAKE-UP call for patients and clinicians: this is how researchers sharing findings of increased cardiovascular risk in prediabetes have characterised their insights. A large-scale retrospective study has shown significantly greater rates of major cardiovascular events in patients with prediabetes.
Prediabetes is a significant and growing healthcare concern amongst the general population. According to the U.S. Centers for Disease Control and Prevention (CDC), 34 million Americans are estimated to have diabetes (over one in 10) and a further 88 million (approximately one in three) estimated to have prediabetes. Whilst current clinical thinking tends to consider prediabetes as a risk for future diabetes, this study demonstrates the significant risks associated with prediabetes itself.
The single-centre study of 25,829 patients compared stroke, heart attack, and other major cardiovascular event rates between those with and without prediabetes, following patients for a 14-year study period. Serious cardiovascular events occurred in 18% of patients with prediabetes, compared with 11% of those with normal blood sugar levels over the median 5-year follow-up. Particularly noteworthy was the finding that lowering blood sugar levels back to normal range in patients with prediabetes did not significantly improve risk for cardiovascular events: just over 10.5% of these patients went on to experience a cardiovascular event, compared with 6% of patients without prediabetes.
After accounting for other factors, including age, gender, BMI, blood pressure, cholesterol, sleep apnoea, smoking, and peripheral artery disease, the relationship between serious cardiovascular events and blood sugar levels remained significant.
“Based on our data, having prediabetes nearly doubled the chance of a major adverse cardiovascular event, which accounts for 1 out of 4 deaths in the U.S.,” said Adrian Michel, lead author and Internal Medicine Resident at Beaumont Hospital, Royal Oak, Michigan, USA. He highlighted that inflammatory injury to vessels and cardiac vasculature is thought to be the mechanism by which high blood sugar levels and prediabetes leads to major cardiovascular events. “As clinicians, we need to spend more time educating our patients about the risk of elevated blood sugar levels and what it means for their heart health and consider starting medication much earlier or more aggressively, and advising on risk factor modification, including advice on exercise and adopting a healthy diet.”