Association between prediabetes and risk of all cause mortality and cardiovascular disease: updated meta-analysis

BMJ 2020; 370 (Published 15 July 2020)

Objective
To evaluate the associations between prediabetes and the risk of all cause mortality and incident cardiovascular disease in the general population and in patients with a history of atherosclerotic cardiovascular disease.

Review methods
Prospective cohort studies or post hoc analysis of clinical trials were included for analysis if they reported adjusted relative risks, odds ratios, or hazard ratios of all cause mortality or cardiovascular disease for prediabetes compared with normoglycaemia.

The primary outcomes were all cause mortality and composite cardiovascular disease. The secondary outcomes were the risk of coronary heart disease and stroke.[/color]

Results
A total of 129 studies were included, involving 10?069?955 individuals for analysis.

In the general population, prediabetes was associated with an increased risk of all cause mortality, composite cardiovascular disease , coronary heart disease and stroke in a median follow-up time of 9.8 years.

Compared with normoglycaemia, the absolute risk difference in prediabetes for all cause mortality, composite cardiovascular disease, coronary heart disease, and stroke was , 8.75 (6.41 to 10.49), 6.59 (4.53 to 8.65), and 3.68 (2.10 to 5.26) per 10?000 person years, respectively.

Impaired glucose tolerance carried a higher risk of all cause mortality, coronary heart disease, and stroke than impaired fasting glucose.[/color]

Compared with normoglycaemia, in patients with atherosclerotic cardiovascular disease,[/b] the absolute risk difference in prediabetes for all cause mortality, composite cardiovascular disease, coronary heart disease, and stroke was 66.19 , 189.77 , 40.62, , and 8.54 per 10 000 person years, respectively [/color][/b]

No significant heterogeneity was found for the risk of all outcomes seen for the different definitions of prediabetes in patients with atherosclerotic cardiovascular disease

Conclusions
Results indicated that prediabetes was associated with an increased risk of all cause mortality and cardiovascular disease in the general population and in patients with atherosclerotic cardiovascular disease. Screening and appropriate management of prediabetes might contribute to primary and secondary prevention of cardiovascular disease.