Prediabetes study details, MACE link

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The incidence of major adverse cardiovascular events (MACE) in the prediabetes group (17.97%; 95% confidence interval [CI], 17.3-18.63%) was significantly higher than the incidence observed in the control group (11.01%; 95% CI 10.48-11.55%) (P<.0001 according to the study published in rel="noopener" href="https://www.jacc.org/doi/10.1016/S0735-1097%2821%2901357-7" target="_blank">Journal of the American College of Cardiology. MACE is defined as any stroke, myocardial infarction, unstable angina, or acute coronary syndrome.

In addition, MACE occurred in 10.5% of patients with prediabetes whose blood sugar returned to normal, compared to 6% of patients without diabetes and prediabetes.

“In general, we tend to view prediabetes as a problem. But we found that prediabetes itself can dramatically increase a person’s chances of having a major cardiovascular event, even if they never progress to diabetes, ” mentionned senior author Adrian Michel, MD, resident in internal medicine at Beaumont-Royal Oak Hospital, Michigan. “Instead of preventing diabetes, we need to change direction and prevent prediabetes. “

CDC estimates In 2018, 34 million Americans, or just over 1 in 10, had diabetes, and 88 million, or 1 in 3, had prediabetes.

The researchers looked at the charts of 25,829 patients in the Beaumont health system and divided them into a prediabetes group and a control group. Data were collected from 2006 to 2020. Patient follow-up was carried out over a period of 14 years.

The relationship between higher blood sugar and MACE remained significant even after taking into account other potentially contributing factors including age, gender, body mass index, blood pressure, cholesterol, sleep apnea, smoking and peripheral artery disease.

Overall, the relationship was strongest among men, blacks, and people with a family history of cardiovascular disease or personal risk factors for heart disease. Among all the patients, those who were overweight had the highest incidence of MACE.

The authors also called for more research.

“According to our data, prediabetes almost doubled the risk of a major adverse cardiovascular event, which accounts for 1 in 4 deaths in the United States,” said Michel. “As clinicians, we need to spend more time educating our patients about the risk of high blood sugar and what it means for their heart health and consider starting medications much earlier or more aggressively, and counseling on the modification of risk factors, including advice on exercise and adopting a healthy diet.

Prediabetes is thought to play a role in heart health because high levels of glucose in the blood can damage and cause inflammation in the vessels. This can lead to damage to vessels in the body and can narrow the vessels and ultimately cause cardiovascular damage, Michel said.

Prediabetes is suspected when a patient has a glycated hemoglobin level between 5.7 and 6.4%, a fasting blood sugar level of 100-125 mg / dl, or an oral glucose tolerance test of 140-199 mg / dl, according to the American Diabetes Association.

Reference:

Michel A, Mando R, Waheed MA, Halalau A and Karabon P. Prediabetes associated with an increase in major adverse cardiovascular events. J Am Coll Cardiol. Published online May 16, 2021. doi: 10.1016 / S0735-1097% 2821% 2901357-7



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