Prediabetes meeting both fasting glucose and HbA1c criteria was associated with the highest risk of coronary artery calcification progression, with a 5.4% higher annual progression rate compared to normoglycemia.
Cohort (n=146,436)
Yes
Does prediabetes defined by different diagnostic criteria increase the prevalence and progression of coronary artery calcification in adults without diabetes?
Prediabetes, particularly when meeting both fasting glucose and HbA1c criteria, is significantly associated with an increased risk and progression of subclinical coronary atherosclerosis.
Effect estimate: Ratio 1.054 (95% CI 1.047-1.062)
Absolute Event Rate: 11.4% vs 6.1%
AIM: To investigate the associations between prediabetes defined by different diagnostic criteria and coronary artery calcification (CAC) and its progression over time. MATERIALS AND METHODS: This cross-sectional study included 146 436 Korean adults without diabetes who underwent CAC estimation computed tomography (CT) during health examinations from 2011 to 2019. We used multinomial logistic regression models. The longitudinal study comprised 41 100 participants with at least one follow-up cardiac CT and annual CAC progression rates and ratios were estimated. Prediabetes was categorized into three groups: isolated glucose prediabetes (fasting blood glucose FBG 100-125 mg/dl, HbA1c < 5.7%), isolated HbA1c prediabetes (FBG < 100 mg/dl, HbA1c 5.7%-6.4%) and prediabetes meeting both FBG and HbA1c criteria (FBG 100-125 mg/dl, HbA1c 5.7%-6.4%). RESULTS: After adjusting for covariates, the prevalence ratios (95% CI) for CAC scores of more than 100 comparing isolated glucose prediabetes, isolated HbA1c prediabetes and prediabetes fulfilling both criteria with those of normoglycaemia were 1.12 (0.99-1.26), 1.24 (1.11-1.39) and 1.31 (1.18-1.45), respectively. The multivariable-adjusted ratio (CIs) of annual CAC progression rates comparing the corresponding groups with the normoglycaemia group were 1.031 (1.023-1.039), 1.025 (1.019-1.032) and 1.054 (1.047-1.062), respectively. CONCLUSIONS: CAC risk and CAC progression were consistently highest in individuals meeting both glucose and HbA1c criteria, while all three prediabetes types showed a significantly increased risk of CAC progression. Atherosclerosis risk reduction management is necessary for prediabetes, especially in patients meeting both criteria.
Choi et al. (Mon,) conducted a cohort in Prediabetes and Coronary Artery Calcification (n=146,436). Combined prediabetes (meeting both fasting glucose and HbA1c criteria) vs. Normoglycemia (FBG < 100 mg/dl and HbA1c < 5.7%) was evaluated on Annual coronary artery calcification (CAC) progression rate (Ratio 1.054, 95% CI 1.047-1.062). Prediabetes meeting both fasting glucose and HbA1c criteria was associated with the highest risk of coronary artery calcification progression, with a 5.4% higher annual progression rate compared to normoglycemia.