Response to Comment on Kiviniemi et al. Prediabetes and Risk for Cardiac Death Among Patients With Coronary Artery Disease: The ARTEMIS Study. Diabetes Care 2019;42:1319–1325

We appreciate the comments by Chattopadhyay and John (1) on our recent study on prognostic significance of prediabetes in patients with stable coronary artery disease (CAD) (2).They raise concerns about a selfselected low-risk population, which they claim compromises the generalization of the results.The aim of the Innovation to Reduce Cardiovascular Complications of Diabetes at the Intersection (ARTEMIS) study was to assess prognostic significance of prediabetes among CAD patients in stablephase CAD.Approximately half had history of myocardial infarction (MI).Authors Chattopadhyay and John are correct that patients with severe cardiac condition were excluded (2) and some may have even died before enrollment.In this case, it would be interesting to know whether treatment of prediabetes could improve prognosis among patients at highest risk for cardiac death in short-term follow-up.Chattopadhyay and John were interested to find out the Global Registry of Acute Coronary Events (GRACE) score of the patients of the ARTEMIS study.The median GRACE score (1st to 3rd quartile) at enrollment was 89 (77-101) and 87 (73-97) for patients with prediabetes and normal glycemic status (NG), respectively (P 5 0.001), representing somewhat intermediate risk on average.Notably, a higher GRACE score in the patients with prediabetes did not convert into worse prognosis.Also, SYNTAX scores, presented in our original study (2), were measured