Читать книгу Clinical Dilemmas in Diabetes - Группа авторов - Страница 24

There is an increased prevalence of cardiovascular disease (CVD) in individuals with prediabetes, but this relationship is confounded by common‐risk factors present in CVD and prediabetes [66–68]. However, after accounting for non‐glycemic cardiovascular risk factors, both IFG and IGT are still associated with a modestly increased risk of developing CVD. It is possible that much of this risk is due to the increased risk of ultimately progressing to DM.

Approximately 25% of first myocardial infarctions (MIs) are unrecognized, which are predictive of future major cardiovascular events including death [69]. In a multi‐ethnic population‐based cohort study adjusted for cardiovascular risk factors, it was shown that subjects with IFG have a higher prevalence of unrecognized MIs than those with NFG, with an odds ratio of 1.60 (95% CI 1.01–2.48).

In the Whitehall Study, after 5–10 years of follow‐up, survival by baseline glucose tolerance status diverged among the groups, and median survival differed by approximately 4 years between the normoglycemic and glucose intolerant groups [70]. Overall, all‐cause mortality, cardiovascular mortality, and respiratory mortality were higher among participants with glucose intolerance. The hazard of coronary mortality rose beginning at a 2‐h PG of 83 mg/dL; however, the graded relationship diminished after adjusting for multiple variables including baseline CVD.

A systematic review and meta‐analysis incorporated 53 prospective studies with 1 611 339 subjects who were followed for a median of 9.5 years for cardiovascular and mortality outcomes [68]. IFG and IGT diagnostic criteria were in accordance with 2020 ADA guidelines [1]. Compared to individuals with normoglycemia, those with IGT or IFG had an increased risk of composite CVD (relative risk (RR) 1.13 for IFG and 1.30 for IGT), coronary heart disease (RR 1.10 for IFG and 1.20 for IGT), stroke (RR 1.06 for IFG and 1.20 for IGT), and all‐cause mortality (RR 1.13 for IFG and 1.32 for IGT). One limitation of this systematic review and meta‐analysis is that some of the included studies did not adjust for progression to DM during the follow‐up period.

A separate meta‐analysis examined 102 prospective studies with 698 782 subjects and showed that FPG was modestly and non‐linearly associated with vascular disease, with hazard ratios for coronary heart disease of 1.11 for FPG of 5.6–6.09 mmol/L and 1.17 for FPG of 6.1–6.99 mmol/L [71]. Another meta‐analysis that included 97 prospective studies with 820 900 subjects calculated hazard ratios for cause‐specific death according to baseline FPG [72]. After adjusting for multiple variables and excluding subjects with known CVD at baseline, FPG was found to be nonlinearly related to risk of death. Compared with subjects with NFG, subjects with IFG had hazard ratios of 1.13 for cancer deaths, 1.17 for vascular deaths, and 1.12 for non‐cancer and non‐vascular deaths.