Prediabetes and Risk for Cardiac Death Among Patients With Coronary Artery Disease
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- This study examined long-term cardiac mortality in a cohort of 1948 patients with stable coronary artery disease (CAD) according to glycemic status (normal, prediabetes, and type 2 diabetes). After 6.3 years of follow-up, the rates of cardiac death and major adverse cardiac events (MACE) were similar between the participants with a normal glycemic status and the participants with prediabetes. Participants with type 2 diabetes had higher rates of cardiac death and MACE than the other two groups.
- The findings of this study indicate that prediabetes glycemic status does not appear to confer an increase in risk for cardiac death or MACE.
abstract
This abstract is available on the publisher's site.
Access this abstract nowOBJECTIVE
To compare cardiac mortality in patients with CAD and prediabetes with that in patients with normal glycemic status and type 2 diabetes.
RESEARCH DESIGN AND METHODS
The Innovation to Reduce Cardiovascular Complications of Diabetes at the Intersection (ARTEMIS) study included patients with CAD after revascularization (79%), optimal medical therapy, or both. Patients had type 2 diabetes (n = 834), impaired glucose tolerance (IGT; n = 314), impaired fasting glucose (IFG; n = 103), or normal glycemic status (n = 697) as defined on the basis of the results of an oral glucose tolerance test. The primary end point was cardiac death. Major adverse cardiac event (MACE; cardiac death, heart failure, or acute coronary syndrome) and all-cause mortality were secondary end points.
RESULTS
During a mean ± SD follow-up of 6.3 ± 1.6 years, 101 cardiac deaths, 385 MACEs, and 208 deaths occurred. Patients with IGT tended to have 49% lower adjusted risk for cardiac death (P = 0.069), 32% lower adjusted risk for all-cause mortality (P = 0.076), and 36% lower adjusted risk for MACE (P = 0.011) than patients with type 2 diabetes. The patients with IFG had 82% lower adjusted risk for all-cause mortality (P = 0.015) than the patients with type 2 diabetes, whereas risks for cardiac death and MACE did not differ significantly between the two groups. The adjusted risks for cardiac death, MACE, and all-cause mortality among patients with IGT and IFG did not significantly differ from those risks among patients with normal glycemic status.
CONCLUSIONS
Cardiac mortality or incidence of MACE in patients with CAD with prediabetes (i.e., IGT or IFG after revascularization, optimal medical therapy, or both) does not differ from those values in patients with normal glycemic status.
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Prediabetes and Risk for Cardiac Death Among Patients With Coronary Artery Disease: The ARTEMIS Study
Diabetes Care 2019 May 10;[EPub Ahead of Print], AM Kiviniemi, ES Lepojärvi, MP Tulppo, OP Piira, TV Kenttä, JS Perkiömäki, OH Ukkola, RJ Myerburg, MJ Junttila, HV HuikuriFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Does prediabetes increase the risk for cardiovascular disease (CVD)? There are two ways to look at this question. Does early dysglycemia increase the risk of developing CVD in patients who do not currently have it and does adding mild dysglycemia to preexisting CVD increase the risk of future events? There is some epidemiological evidence and smaller studies that show that prediabetes does increase the risk of developing CVD.1
In the ARTEMIS study, it was found that prediabetes did not significantly increase the risk of CVD death or other MACE in patients with preexisting CVD. The EUROASPIRE study, in contrast, did show increased risk of MACE in a similar population.2 However, the primary outcomes, number of CVD deaths, and follow-up period between the two studies were different. Additionally, only the impaired 2-hour OGTT (IGT) was actually predictive of increased CVD risk.
The literature supports a conclusion that the additional risk mild dysglycemia adds to the risk of a future event in patients with preexisting CVD is small in contrast to diabetes. IGT may be assessed in this population, as it is most predictive. The focus should be reduction of all traditional CVD risk factors in this mildly dysglycemic population.
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