Prediabetes is independently linked to myocardial infarction

Prediabetes is not only a predictor of diabetes and related cardiovascular complications, but is also a risk factor in itself for myocardial infarctionbased on data from nearly 1.8 million hospitalized patients with myocardial infarction.

“Our study serves as a wake-up call for clinicians and patients to focus on preventing prediabetes, not just diabetes,” Geethika Thota, MD, said at the Endocrine Annual Meeting. Society.

Many data suggest that prediabetes puts patients on a trajectory to cardiovascular disease. In a meta-analysis of 129 studies published 2 years ago, prediabetes was not only associated with a statistically significant 16% increase in coronary heart disease, but also with a 13% increased risk of all-cause mortality compared to people with normoglycemia.

Data from 1.8 million patients

In this study, 1,794,149 weighted patient hospitalizations for myocardial infarction were drawn from the National Inpatient Sample Database. Excluding patients who eventually developed diabetes, about 1% of those patients had a history of prediabetes in the past, according to a search of ICD-10 codes.

Before adjusting for other risk factors, prediabetes was associated with a more than 40% increased risk of myocardial infarction (odds ratio, 1.41; P < .01). After adjusting for a wide range of known risk factors for MI - including history of MI, dyslipidemia, hypertensionnicotine addiction and obesity – prediabetes remains an independent risk factor, corresponding to an increased risk of MI of 25% (OR, 1.25; P < .01).

A history of prediabetes was also an independent risk factor for percutaneous intervention and coronary artery bypass grafting, with a 45% and 95% increased risk, respectively.

As a retrospective study looking at prediabetes as a risk factor in those who have had a prior MI, it’s possible that not all patients with prediabetes were correctly coded, but Thota said it was unlikely likely that it was a problem of sufficient magnitude to have affected the major conclusion.

Relevance seen for community care

Although the study was drawn from hospitalized patients, its relevance is for the community setting, where screening and intervention for prediabetes has the potential to modify risk, according to Thota.

Most clinicians are likely aware of the value of screening for prediabetes, which was defined in this study as a hemoglobin a1c from 5.7% to 6.4%, but Thota suggested many might not fully grasp the full scope of the goals. Early detection and prevention will prevent diabetes and, by extension, cardiovascular disease, but his data suggests that controlling prediabetes with a low cardiovascular risk by a more direct route.

“Despite mounting evidence, many clinicians are unaware that prediabetes is also a major risk factor for atherosclerotic cardiovascular disease“said Thota, an internal medicine resident at Saint Peter’s University Hospital, New Brunswick, NJ.

Like diabetes, the prevalence of prediabetes is increasing rapidly, according to data from the Centers for Disease Control cited by Thota. In 2020, the Centers for Disease Control and Prevention estimated that 38% of the adult population had prediabetes. By 2030, one model predicts an additional 25% growth.

Screening for high blood sugar is part of routine patient evaluations at the Thota center. In an interview, she said that once a diagnosis of prediabetes is entered into the electronic medical record, the history is carried over so that status changes are continuously monitored.

Worsening prediabetes should be treated

“Prediabetes is not treated with medication, at least initially,” Thota explained. Rather, patients are informed of important lifestyle changes, such as diet and physical activity, that can reverse the diagnosis. However, patients who remain on a worsening hyperglycemia pathway are candidates for more intensive lifestyle intervention and could be selectively considered for metformin.

“Early recognition of prediabetes through screening is important,” Thota stressed. The benefit of preventing patients from progressing to diabetes is well recognized, but these data provide the basis for urging patients with prediabetes to change their lifestyle by telling them that it can reduce their risk of heart attack. myocardium.

These data have an important message, but they are not surprising, according to Deepak L. Bhatt, MD, executive director, interventional cardiovascular programs, Brigham and Women’s Hospital Heart & Vascular Center, Boston.

“In fact, in daily practice, we see a substantial percentage of patients with MI who have prediabetes that had not been previously recognized or formally diagnosed,” Bhatt said in an interview.

“Identifying these patients – preferably before presenting with cardiovascular complications – is important both to reduce cardiovascular risk but also to try to prevent the progression of diabetes,” he added.

Bhatt went on to say that this large analysis, confirming that prediabetes is independently associated with myocardial infarction, should prompt clinicians to rigorously screen patients for the condition.

“At a minimum, these patients would be candidates for intensive lifestyle modification aimed at weight loss and treatment of common coexisting conditions, such as hypertension and dyslipidemia,” Bhatt said.

Thota reports no potential conflicts of interest. Bhatt has financial relationships with more than 30 pharmaceutical companies, many of which manufacture products relevant to the management of diabetes and cardiovascular disease.

This article originally appeared on MDedge.comwhich is part of the Medscape professional network.

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