Cardiovascular Mortality in Individuals With Early-, Late-Onset Prediabetes

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Individuals who developed prediabetes that did not progress to diabetes had lower risk for cardiovascular-related mortality.
Individuals who developed prediabetes that did not progress to diabetes had lower risk for cardiovascular-related mortality.

Individuals with early-onset prediabetes may be at higher risk for earlier cardiovascular-related mortality compared with individuals with later-onset prediabetes, whereas individuals at the highest and lowest risk for death because of cardiovascular or coronary vs noncardiovascular disease were those with prediabetes who later developed diabetes and those who maintained a lifelong normal glucose status, respectively, according to a study published in Diabetes Care.

Researchers conducted a retrospective study using data from the Framingham Heart Study in individuals aged 18 to 77 years with recorded fasting plasma glucose assessments from 1983 to 1987, to investigate the frequency of cardiovascular-related death in individuals diagnosed with early- or late-onset prediabetes that never progressed to diabetes. Individuals were classified into 1 of 4 categories: never diagnosed with prediabetes or diabetes, early-onset prediabetes without a later diabetes diagnosis, late-onset prediabetes without a later diabetes diagnosis, and a diagnosis of diabetes.

Study results demonstrated a 50% lifetime prevalence of dysglycemia in the overall sample of individuals (cases and controls) and a 69% prevalence of individuals who were diagnosed with prediabetes but never diabetes. The researchers found a significant increase in the odds of cardiovascular death and coronary heart disease-related death vs death resulting from all other causes in individuals diagnosed with diabetes when compared with control patients who maintained optimal fasting plasma glucose levels throughout their lifetime.

When compared with individuals diagnosed with prediabetes who later were diagnosed with diabetes, those diagnosed with prediabetes and never diabetes were at lower risk for cardiovascular mortality regardless of whether the onset of prediabetes was early in life. The researchers also found a significantly higher increase in the odds of coronary and cardiovascular death in individuals who were diagnosed with prediabetes early compared with later in life, despite never being diagnosed with overt diabetes later in life, compared with those with normal lifetime glucose status.

The researchers concluded that there is greater risk for cardiovascular mortality in individuals with early-onset prediabetes compared with late-onset prediabetes, and that interventions aimed at preventing early-onset prediabetes may reduce the incidence of cardiovascular disease. Therefore, clinicians should continue to encourage individuals with a rising HbA1c or those at high risk of developing prediabetes or diabetes to initiate interventions to lower their levels in an effort to prevent prediabetes and potentially cardiovascular disease.

Reference

Echouffo-Tcheugui JB, Niiranen TJ, McCabe EL, et al. Lifetime prevalence and prognosis of prediabetes without progression to diabetes [published online May 3, 2018]. Diabetes Care. doi: 10.2337/dc18-0524

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