Diabetes Screening Age and the U.S. Preventive Services Task Force Guideline: Does One Size Fit All? Insights from the Middle East

Background: Diabetes mellitus (DM) is a major modifiable risk factor for coronary artery disease, and cardiovascular events can represent the first clinical manifestation of undiagnosed DM. Our study aims to determine the incidence of newly detected cardiovascular risk factors, including DM, prediabetes, dyslipidemia, hypertension, and smoking, among patients presenting with acute coronary syndrome (ACS) in Qatar. Methods: This cross-sectional observational study was included all patients admitted with ST-or non-ST-elevation myocardial infarction (MI) to Heart Hospital, Qatar, between March 1, 2015, and December 31, 2020. Data were extracted from electronic records, including newly diagnosed DM was defined as hemoglobin A1c (HbA1c) ≥6.5%; prediabetes as HbA1c 5.6%-6.4%; dyslipidemia as low-density lipoprotein (LDL) ≥3.3 mmol/L; and familial hyperlipidemia as LDL ≥4.9 mmol/L with a family history. Smoking and hypertension were also recorded. Results: Among 10,450 patients, the mean age of ACS was 51 ± 11 years, and 92.4% were male, 13.2% had newly diagnosed DM, and 21.2% met prediabetes criteria. Dyslipidemia, hypertension, and smoking were newly identified in 30.3%, 38.9%, and 27.3%, respectively. These findings suggest that ACS onset occurred at a markedly younger age compared to international cohorts. Conclusions: Undiagnosed cardiovascular risk factors, particularly DM and prediabetes, are highly prevalent and may be associated with earlier MI. Thus, early screening and preventive strategies should be more targeted and tailored to reflect the distinct cardiometabolic risk profiles of Middle Eastern populations.