Prediabetes goes hand in hand with cardiovascular and renal risk factors
medwireNews: Data from the US NHANES show that a high proportion of adults with prediabetes also have cardiovascular and renal risk factors.
Among 5463 non-pregnant US adults surveyed between 2011 and 2014, 1701 (31.1%) had prediabetes and, of these, 36.6% had hypertension, 51.2% had dyslipidemia, 7.7% had albuminuria, and 4.6% had a reduced estimated glomerular filtration rate (eGFR).
These rates were lower than in people with diagnosed diabetes (1381 people) but higher than in those with normal glycemia (2172 people). For example, dyslipidemia was present in 63.2% and 31.0% of people with diagnosed diabetes and normal glycemia, respectively, and reduced eGFR was identified in a corresponding 11.8% and 3.8%
People with prediabetes also had a large average BMI, at 30.1 kg/m2, compared with 27.3 and 33.0 kg/m2 in those with normal glycemia and diagnosed diabetes, respectively.
The rate of hypertension in people with prediabetes represented a significant increase since the 1988–1994 survey period, by 9.7 percentage points, report Mohammed Ali (Centers for Disease Control and Prevention, Atlanta, Georgia, USA) and study co-authors.
BMI also increased over this time period, but the rates of dyslipidemia and impaired kidney function did not change and there was a 6.4 percentage point decrease in the proportion of current smokers.
Overall, the 10-year cardiovascular risk was significantly lower among people in the most recent survey period compared with those in the earlier surveys. This was particularly true for those with diagnosed diabetes, who were also the most likely to be receiving treatment for hypertension and/or dyslipidemia.
Writing in The Lancet Diabetes & Endocrinology, the researchers note that there is “much room for improvement” in cardiovascular prevention among people with prediabetes; of those with hypertension, around 40% had uncontrolled hypertension, with half of these being untreated, and nearly 70% of those with dyslipidemia were uncontrolled, with only a fraction of these patients receiving medication.
These findings “call for a less diabetes-centric view of prediabetes and instead conceptualise detection of prediabetes as an opportunity for early intervention” to prevent cardiovascular and renal disease, they conclude.
However, in a linked commentary, Mika Kivimäki and Adam Tabák, both from University College London in the UK, observe that intensively treating cardiovascular risk factors in this population may yield only “modest” benefits, given that their 10-year risk according to the AHA/ACC Atherosclerotic Cardiovascular Disease guidelines was 6.9%, which was barely more than the 6.3% risk for people with normal glucose levels. Added to which is the small but significant increased risk for diabetes associated with statin treatment.
By contrast, research shows that intensive preventive measures in patients with prediabetes can delay the onset of type 2 diabetes, and given the size of the population – estimated in the current study as up to 78.5 million Americans – the commentators suggest that the findings offer a way to focus resources towards patients “showing a persistent clustering of prediabetes with other factors that increase the risk of diabetes.”
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