Time for cardiologists to focus on prediabetes: challenges in risk factor control

Background Limited attention has been given to the assessment of cardiovascular risk and conformity to target levels for blood pressure (BP), low-density lipoprotein (LDL), and HbA1c in hospitalized patients with cardiovascular diseases (CVD) based on their glycemic status. Our aim was to assess cardiovascular risk and the conformity of baseline BP, LDL, and HbA1c levels to targets in hospitalized patients with CVD based on the status of dysglycemia. Methods Our study was a single-center observational registry that included 737 patients CVD and hypertension (HTN) admitted to the cardiology department. All of them were screened for dysglycemia using HbA1c and fasting plasma glucose (ADA, 2019). Previously diagnosed type 2 diabetes mellitus (T2DM) was present in 25.1% of patients, 1.9% had previously diagnosed prediabetes, newly diagnosed prediabetes was found in 16.3% of patients, and newly diagnosed T2DM occurred in 10.4% of patients. BP levels were determined on admission, and conformity to targets was based on the European Guidelines on HTN (ESC, 2018). Cardiovascular risk and target LDL levels were defined according to the European Guidelines on dyslipidaemias (ESC, 2019). HbA1с target levels were determined based on the state clinical protocol for T2DM (2022). Results The incidence of very high risk in newly diagnosed prediabetes was comparable to that of newly and previously diagnosed T2DM, but not to patients without these conditions (Fig. 1). However, only the group without dysglycemia and those with previously diagnosed T2DM showed a statistically significant difference (Fig. 1). More than half of the patients without dysglycemia managed target BP levels, but only one-third of dysglycemia, irrespective of its status (p<0.0001, Fig. 2). Moreover, low rates of target LDL levels were reported, regardless of dysglycemia status (Fig. 2). Among patients with newly and previously diagnosed T2DM, over 60% of patients had the target HbA1c level, and this difference was not statistically significant (Fig. 2). At the same time, only 2.5% of patients with newly diagnosed prediabetes achieved the target level of 2 indicators, as opposed to 11.1%, 29.9% and 24.9% of patients without dysglycemia, and those with newly and previously diagnosed T2DM, respectively (p<0.0001). Additionally, only 6.5% and 2.7% of patients with newly and previously diagnosed T2DM achieved the target level of all 3 indicators. Conclusions Hospitalized patients with CVD, regardless of the presence of dysglycemia, exhibit inadequate adherence to target levels for a combination of BP, LDL, and HbA1c. Furthermore, the lowest baseline adherence to target levels for BP and LDL is observed in patients with newly diagnosed prediabetes. These findings underscore the potential impact on long-term treatment strategies and emphasize the importance of managing prediabetes effectively.