Insulin resistance as a key risk factor for cardiovascular complications in prediabetes: Early therapeutic options

Despite significant advances in the treatment of cardiovascular diseases (CVD) over the past two decades, they remain the leading cause of death worldwide. Type 2 diabetes mellitus (T2DM) and prediabetes are widespread among people with CVD and are associated with adverse outcomes. The widespread occurrence of carbohydrate disorders in the population is mainly associated with the development of insulin resistance (IR), which is most often the earliest defect formed at the earliest stages of cardiorenometabolic syndrome. Meta-analyses of observational studies have shown that middle-aged adults with prediabetes have an increased risk of atherosclerotic cardiovascular disease (ARVD), heart failure, and all-cause mortality. According to the latest data, in a 30-year risk analysis, prediabetes was moderately associated with the risk of complications such as CVD, chronic heart failure, chronic kidney disease, and all-cause mortality, compared with normoglycemia. This association remained significant even after taking into account the progression to T2DM (HR 1.18; 95% CI: 1.12–1.24), and 85% (95% CI: 75–94%) of the excess risk of developing any complications with prediabetes remained. That is, the progression of T2DM explains less than a quarter of the risks of clinical outcomes associated with prediabetes. In other words, prediabetes contributes to the risk of adverse clinical outcomes even without T2DM progression. And complex therapy aimed at correcting IR can ensure better compensation and prevent the development of a cascade of cardiometabolic disorders. This review will focus on the role of IR and prediabetes in the development of CVD and the long-term benefits of timely diagnosis and therapy of early carbohydrate metabolism disorders.