Prediabetes Independently Associated with MI, PCI, CABG: A "Wake-up Call," Study Authors Say

Prediabetes appears to be a strong and independent risk factor for myocardial infarction (MI), according to study findings presented at ENDO 2022, the Endocrine Society’s annual meeting in Atlanta, Ga.

The study of data from nearly 2 million hospitalizations further found a significant increase in risk among persons with prediabetes for percutaneous coronary intervention (PCI) and for coronary artery bypass grafting (CABG).

Study authors, led by Geethika Thota, MD, Saint Peter’s University Hospital/Rutgers Robert Wood Johnson Medical School in New Jersey, set out to build on the large body of evidence that has established type 2 diabetes (T2D) as a well-known risk factor for cardiovascular disease (CVD), pointing to growing research interest in a possible link between risk for MI and prediabetes. Prediabetes, as defined in the study abstract, is HbA1c 5.7 - 6.4% "with an intermediate metabolic state and includes impaired glucose tolerance and impaired fasting glucose due…”

For their analysis, the researchers tapped the National Inpatient Sample for adult patients admitted to US teaching hospitals with a primary or secondary diagnosis of "acute myocardial infarction" during sample years 2016-2018. They created 3 multivariate logistic regression models to explore the associations between prediabetes and MI, PCI, and CABG.

The analysis included 1 794 149 weighted hospitalizations with MI of which 1% had prediabetes. Thota et al found prediabetes was significantly associated with increased odds for MI (OR 1.41, 95% CI 1.35-1.47, P=.000).

After multivariable regression, adjusting for age, sex, race, family history of MI, dyslipidemia, hypertension, diabetes, smoking, and obesity, prediabetes remained significantly associated with increased odds of MI (OR 1.25, 95% CI 1.20-1.31, P=.000). Investigators also found prediabetes associated with significantly increased odds of undergoing PCI (OR 1.45, 95% CI 1.37-1.53, P=0.000) and of undergoing CABG (OR 1.95, 95% CI 1.77-2.16, P=.000).

Thota and colleagues write that even after controlling for all of the well-established risk factors, prediabetes persisted as an independent risk factor for MI. The strong associations of prediabetes with interventional procedures, PCI and CABG, they continue, suggest the presence of macrovascular coronary artery disease.

The authors point to one study limitation—that prediabetes is often overlooked or missed when a clinic visit is coded, but they stand by their findings as important additions to the literature on the relationship between the earliest signs of T2D and subsequent CVD.

They conclude: “Our study serves as a wake-up call for clinicians and patients to shift the focus to preventing prediabetes and not just diabetes. Our findings reinforce the importance of early recognition by screening and early intervention of prediabetes by lifestyle changes and/or medications to decrease the risk of cardiovascular events.”

Reference: Pillai KJ, Luo Hongxiu, Raj K, et al. Prediabetes is a risk factor for myocardial infarction - a national inpation sample study. Abstract presented at ENDO 2022; June 11-14, 2022; Atlanta, Georgia.