Prediabetes may up MI, PCI, CABG risk

Individuals with prediabetes appear to be at an elevated risk of developing myocardial infarction (MI) as well as requiring coronary interventions, according to a study presented at ENDO 2022.

“Our study shows that prediabetes may be an independent risk factor for MI despite adjusting for the well-established risk factors,” said study lead author Dr Geethika Thota from Saint Peter’s University Hospital/Rutgers Robert Wood Johnson Medical School in New Brunswick, New Jersey, US.

“Our study serves as a wake-up [call] to everyone to shift the focus to managing prediabetes, not just diabetes,” she continued.

Using the National Inpatient Sample, Thota and co-authors identified 1,794,149 adults aged ≥50 years with a primary or secondary diagnosis of acute MI admitted to teaching hospitals between 2016 and 2018. Of these, 1 percent (n=330,814) had prediabetes (HbA_1c 5.7–6.4 percent with an intermediate metabolic state*).

After adjusting for age, sex, race, family history of MI, dyslipidaemia, hypertension, diabetes, nicotine dependence, and obesity, individuals with prediabetes had a significantly increased risk of MI (adjusted odds ratio [adjOR], 1.25, 95 percent confidence interval [CI], 1.20–1.31). [ENDO 2022, abstract OR02]

Individuals with prediabetes were also at a significantly increased risk of requiring percutaneous coronary intervention (PCI; adjOR, 1.45, 95 percent CI, 1.37–1.53) or coronary artery bypass grafting (CABG; adjOR, 1.95, 95 percent CI, 1.77–2.16).

“Coronary interventions such as PCI and CABG were highly associated with prediabetes, suggesting macrovascular coronary artery disease,” said Thota.

“Diabetes mellitus is a well-established risk factor for atherosclerotic cardiovascular disease (ASCVD),” said Thota. “However, despite mounting evidence, clinicians are unaware that prediabetes is also a major risk factor for ASCVD.”

“Our findings reinforce the importance of early recognition by screening and early intervention of prediabetes by lifestyle changes and/or medications to decrease the risk of cardiovascular events,” she continued.

“[W]e encourage everyone to make lifestyle changes, follow a healthy diet, and regularly exercise for at least 150 minutes each week ... to decrease the risk of heart attacks,” Thota said.

She acknowledged certain limitations including the retrospective study design and the potential for missed diagnosis of prediabetes during coding. Furthermore, a majority of individuals with prediabetes are in the community or present at clinics rather than in the hospital which is the basis of the data.

*also included patients with impaired glucose tolerance and impaired fasting glucose due to insulin resistance