Can prediabetes diagnosed using HemoglobinA1c or oral glucose tolerance test predict presence and severity of coronary artery disease in symptomatic patients?

Q: What are the key findings of this study?

Prediabetes defined by HbA1c was associated with a significantly increased risk of severe coronary artery calcification (CAC >400) with an OR of 2.1 compared to normal HbA1c.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Suspicion of chronic coronary syndrome (CCS) (n=702). Intervention: Prediabetes diagnosed by HbA1c vs. Normal HbA1c. Primary outcome: Coronary artery calcium (CAC) >400 (OR 2.1, 95% CI 1.3-3.5, p=<0.05).

Q: What does this research mean for the field?

Prediabetes defined by HbA1c independently predicts the presence and severity of coronary artery disease, conferring a more than two-fold increased risk of severe coronary artery calcification (CAC >400), whereas prediabetes defined by OGTT does not. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Katrine Schultz Overgaard; Thomas Rueskov Andersen; Roda Abdulkadir Mohamed; Laurits Juhl Heinsen; Helle Glud Binderup; Sören Möller; Søren Auscher; Jess Lambrechtsen; Kenneth Egstrup

doi:10.1177/14791641231179870

May 1, 2023Diabetes and Vascular Disease ResearchOpen Access

Can prediabetes diagnosed using HemoglobinA1c or oral glucose tolerance test predict presence and severity of coronary artery disease in symptomatic patients?

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Key result

Prediabetes by HbA1c is linked to a ~2-fold higher risk of severe CAC.

OR 2.1
95% CI 1.3-3.5
P<0.05
n=702

Figures

Why the study?

It was unclear whether prediabetes diagnosed by HbA1c or OGTT could predict the presence and severity of CAD in symptomatic patients.

Does prediabetes diagnosed by HbA1c or OGTT predict the presence and severity of coronary artery disease in symptomatic patients?

Study Design

Type

Cross-Sectional (n=702)

Blinding

Open-label

Multicenter

No

Structured PICO

Does prediabetes diagnosed by HbA1c or OGTT predict the presence and severity of coronary artery disease in symptomatic patients?

P

Population

702 adult patients with suspected chronic coronary syndrome undergoing coronary CT angiography, evaluated for prediabetes using HbA1c and OGTT.

E

Exposure

Prediabetes diagnosed by HbA1c (39-47 mmol/mol or 5.7-6.4%) or OGTT (impaired fasting glucose and/or impaired glucose tolerance).

C

Comparator

Normal glycemic status by HbA1c (<39 mmol/mol) or OGTT.

O

Outcome

Presence and severity of coronary artery disease evaluated by CCTA (CAC >400, plaque presence, significant stenosis).surrogate

Main Result

Odds Ratio: 2.1 (95% CI 1.3–3.5)

Absolute Event Rate: 23% vs 10%

p-value: p=<0.05

HbA1c is a better predictor of coronary artery disease severity than OGTT in patients with suspected chronic coronary syndrome, supporting its use for prediabetes screening in this population.

Limitations

Cross-sectional design with no possibility to repeat glycemic measures
Lack of prospective follow-up to evaluate the progression to T2DM and CV events
Inability to perform contrast scan in patients with CAC >1000
Lack of prospective follow-up to evaluate progression to T2DM and CV events

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Implication

HbA1c-defined prediabetes was associated with severe CAC; leaves open whether it improves risk stratification over OGTT in symptomatic patients.

Abstract

We investigated whether prediabetes diagnosed by hemoglobinA1c (HbA1c) or oral glucose tolerance test (OGTT) could predict presence and severity of coronary artery disease (CAD) in symptomatic patients. The presence of plaque, stenosis, plaque characteristics, and coronary artery calcium (CAC) were evaluated by coronary CT angiography in 702 patients with suspicion of CAD. Patients were classified by glycemic status using the American Diabetes Association criteria for HbA1c and OGTT, and compared to their respective normal ranges. Prediabetes was observed in 24% by HbA1c and 72% by OGTT. Both prediabetes classifications were associated with increased presence of plaque, stenosis, calcified plaques, CAC >400, and a lower frequency of zero CAC compared to their respective normal range (all, p < 0.05). After adjusting for potential confounders, patients with HbA1c-prediabetes had an odds ratio of 2.1 (95% CI: 1.3–3.5) for CAC >400 and 1.5 (95% CI: 1.0–2.4) for plaque presence, while none of the associations for OGTT-prediabetes were significant. The receiver operating characteristic-curve for HbA1c-prediabetes showed an area under the curve of 0.81 for CAC >400 and 0.77 for plaque presence. Prediabetes defined by HbA1c predicts presence and severity of CAD. Although OGTT identified more patients with prediabetes, their risk of CAD were not explained by prediabetes using these diagnostic-criteria.

Discussion

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Cite This Study

Overgaard et al. (2023) conducted a cross-sectional in Suspicion of chronic coronary syndrome (CCS) (n=702). Prediabetes diagnosed by HbA1c vs. Normal HbA1c was evaluated on Coronary artery calcium (CAC) >400 (OR 2.1, 95% CI 1.3-3.5, p=<0.05). Prediabetes defined by HbA1c was associated with a significantly increased risk of severe coronary artery calcification (CAC >400) with an OR of 2.1 compared to normal HbA1c.

synapsesocial.com/papers/6a1fd5afeea2c6885e117fa9 https://doi.org/10.1177/14791641231179870

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Can prediabetes diagnosed using HemoglobinA1c or oral glucose tolerance test predict presence and severity of coronary artery disease in symptomatic patients?

Figures

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Can prediabetes diagnosed using HemoglobinA1c or oral glucose tolerance test predict presence and severity of coronary artery disease in symptomatic patients?

Figures

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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