Among those treated for CAD, pre-DM is not associated with increased event risk

  • Kiviniemi AM & al.
  • Diabetes Care
  • 10 May 2019

  • International Clinical Digest
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Takeaway

  • Among patients with coronary artery disease (CAD) treated with revascularization and/or medical therapy, cardiac event risk is comparable among those with prediabetes and normoglycemia, with both below that of those with type 2 diabetes (T2D).  
  • Efforts should target preventing progression from prediabetes to T2D.  

Why this matters

  • T2D worsens the prognosis of patients with CAD and recent myocardial infarction.

Study design

  • Study of patients with CAD after revascularization (79%) and/or optimal medical therapy, including 834 with T2D, 417 prediabetes (impaired glucose tolerance [IGT] or impaired fasting glucose [IFG]), and 695 normal glucose (NG).
  • Funding: Several non-industry Finnish institutions.

Key results

  • During mean 6.3-year follow-up, cardiac mortality for those with T2D, IGT, IFG, and NG was 8.2%, 3.8%, 2.9%, and 2.6%, respectively.
  • Adjusted risks for cardiac death, major adverse cardiac events (cardiac death, heart failure, or acute coronary syndrome), and all-cause mortality (ACM) did not differ between IFG/IGT and NG groups.
  • IFG/IGT group had significantly lower adjusted risks for cardiac death (HR, 0.44; P=.021), major adverse cardiac event (0.63; P=.003), and ACM (0.57; P=.008) vs patients with T2D.

Limitations

  • Small numbers of some endpoints.
  • Newer glucose-lowering agents not commonly used at time of study.
  • No formal/consistent glucose testing during follow-up.

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