medwireNews: Prediabetes is associated with an elevated risk for all-cause mortality and cardiovascular events, both in the general population and in patients with atherosclerotic cardiovascular disease (CVD), shows an updated meta-analysis published in The BMJ.
Yuli Huang, from Southern Medical University in Foshan, China, and co-authors say that since their 2016 meta-analysis demonstrating that prediabetes is significantly associated with mortality and CVD risk in the general population, many subsequent studies investigating this association have been published, but have “had limited power to draw solid conclusions […], and their results have been debated.”
They add: “Given these inconsistencies, we performed an updated meta-analysis to analyse the available data on the prognostic value of prediabetes in individuals with and without baseline atherosclerotic cardiovascular disease.”
The updated meta-analysis included 129 studies involving a total of 10,069,955 individuals. In the general population (n=97 studies), people with prediabetes had a significantly higher risk for all-cause mortality, composite CVD, coronary heart disease, and stroke than those without prediabetes during a median follow-up of 9.8 years, with relative risks (RRs) of 1.13, 1.15, 1.16, and 1.14, respectively.
Huang and team say that there was “significant heterogeneity” in the risk for mortality and CVD in the general population depending on which definition of prediabetes was used. For instance, the association with all-cause mortality risk was significant when prediabetes was defined as impaired fasting glucose (IFG) according to ADA or World Health Organization (WHO) criteria, but not when using these organizations’ definitions based on glycated hemoglobin levels.
The researchers also point out that the association between IFG and all-cause mortality risk “was mainly attributed to fasting plasma glucose concentrations in the range 6.1–6.9 mmol/L [110.0–124.3 mg/dL],” ie, the WHO IFG-based definition of prediabetes.
In patients with pre-existing atherosclerotic CVD (n=32 studies), prediabetes was associated with a significantly elevated risk for all-cause mortality (RR=1.36), CVD (RR=1.37), and coronary heart disease (RR=1.15) over a median follow-up of 3.2 years. However, there was no significant association between prediabetes and stroke risk in patients with CVD.
The study authors note that in contrast to the general population results, “[d]ifferent definitions of prediabetes were associated with a similar prognosis in patients with a history of cardiovascular disease.”
Taken together, these findings suggest that “[s]creening and appropriate management of prediabetes might contribute to primary and secondary prevention of cardiovascular disease,” say Huang and team.
And they conclude: “Considering the high prevalence of prediabetes, and the robust and significant association between prediabetes and health risk shown in our study, successful intervention in this large population could have a major effect on public health.”
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