Prediabetes may be an independent risk factor for myocardial infarction

Even prediabetes seemed like bad news for heart health, according to a nationwide study of a sample of hospitalized patients.

Prediabetes – defined as an Hba1c between 5.7% and 6.4% – in hospitalized patients was associated with a 41% higher risk of myocardial infarction (IM, OR 1.41, 95% CI 1 ,35-1.47) in a general pattern, reported Geethika Thota, MBBS, of Saint Peter’s University Hospital/Rutgers Robert Wood Johnson Hospital in New Brunswick, New Jersey.

And in a model adjusted for multiple factors, including age, sex, race, family history of MI, dyslipidemia, hypertension, diabetes, nicotine addiction, and obesity status , the presence of prediabetes was still significantly associated with a higher risk of MI (OR 1.25, 95% CI 1.20-1.31).

“Prediabetes was an independent risk factor for myocardial infarction, despite adjusting for all well-established risk factors,” Thota explained in a presentation at ENDO 2022, the annual meeting of the Endocrine Society. “Prediabetes is real. Don’t let ‘pre’ fool anyone.”

In addition to this, prediabetes was also linked to a higher odds of having percutaneous coronary intervention (OR 1.45, 95% CI 1.37-1.53) and a higher odds of getting bypass surgery aortocoronary artery (OR 1.95, 95% CI 1.77-2.16) in adjusted patients. models.

Thota pointed out that these results suggest that there is a heavy burden of coronary macrovascular disease associated with prediabetes. “With our study, we would like to emphasize that this is a red flag for clinicians, as well as patients,” Thota explained. “[We need to] shift the focus to preventing prediabetes and not just diabetes.”

“Our findings would also reinforce the importance of early recognition through screening and early intervention to aggressively manage cardiovascular risk factors to prevent myocardial infarction,” she said.

Thota suggested following the recommendations of the American Diabetes Association (ADA) 2022 “Standards of Medical Care in Diabetes” guidelines, and to screen all patients over 35 for prediabetes. Additionally, ADA guidelines recommend testing all people living with HIV, all women with gestational diabetes, and overweight or obese adults (BMI greater than 25 or greater than 23 for Asian Americans ) with a specific underlying risk factor.

“Early intervention is key,” Thota said, noting that the most important interventions include changes in diet, physical activity and lifestyle, and adding that “metformin and receptor agonists GLP-1 can also be used”.

Thota and colleagues relied on 1,794,149 hospital admissions to teaching hospitals for patients admitted with a primary or secondary diagnosis of acute MI. The data was collected between 2016 and 2018. Of these patients, 1% had prediabetes. This represented a sample of 330,814 patients with prediabetes.

Limitations of the study included the retrospective design and the fact that prediabetes can often be missed when coding the ICD, although Thota noted that teaching hospitals tend to code a little better on this.

She also pointed out that the majority of people with prediabetes are not in the hospital, but rather in the community and clinics. She cautioned that the study sample of hospitalized patients represented a subset of patients with prediabetes.

  • Kristen Monaco is a staff writer, specializing in endocrinology, psychiatry and nephrology news. Based in the New York office, she has been with the company since 2015.

Disclosures

Thota did not disclose any relationship with the industry.

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