Leigh Perreault1, Kristine Færch2, Edward W Gregg3. 1. University of Colorado Anschutz Medical Campus, mailstop F8106, P.O. Box 6511, Aurora, CO, 80045, USA. Leigh.perreault@ucdenver.edu. 2. Steno Diabetes Center Copenhagen, Gentofte, Denmark. 3. Centers for Disease Control and Prevention, Atlanta, GA, USA.
Abstract
PURPOSE OF REVIEW: We reviewed published literature to determine the relationship between A1c and cardiovascular disease (CVD) and summarize the need and implications for CVD risk reduction with interventions, focusing in the prediabetic A1c range (<6.5%). RECENT FINDINGS: Strong evidence supports a continuous relationship between A1c and CVD-even below the current levels of A1c-defined prediabetes and after adjustment for known risk factors for CVD. Clinical trials have demonstrated a reduction in CV morbidity and/or mortality when interventions are invoked in the prediabetic A1c range. Guidelines advocating CV risk factor management in prediabetes have not been widely adopted, subsequently leading to comparable coronary heart disease risk between people with prediabetes (HR = 1.9, 95% CI 1.7-2.1 vs normoglycemia) and diabetes itself (HR=2.0, 95% CI 1.8-2.2 vs no diabetes). This review highlights the missed opportunity to utilize multiple risk factor interventions to reduce CVD in high-risk people with prediabetes.
PURPOSE OF REVIEW: We reviewed published literature to determine the relationship between A1c and cardiovascular disease (CVD) and summarize the need and implications for CVD risk reduction with interventions, focusing in the prediabetic A1c range (<6.5%). RECENT FINDINGS: Strong evidence supports a continuous relationship between A1c and CVD-even below the current levels of A1c-defined prediabetes and after adjustment for known risk factors for CVD. Clinical trials have demonstrated a reduction in CV morbidity and/or mortality when interventions are invoked in the prediabetic A1c range. Guidelines advocating CV risk factor management in prediabetes have not been widely adopted, subsequently leading to comparable coronary heart disease risk between people with prediabetes (HR = 1.9, 95% CI 1.7-2.1 vs normoglycemia) and diabetes itself (HR=2.0, 95% CI 1.8-2.2 vs no diabetes). This review highlights the missed opportunity to utilize multiple risk factor interventions to reduce CVD in high-risk people with prediabetes.
Authors: Elizabeth Selvin; Michael W Steffes; Hong Zhu; Kunihiro Matsushita; Lynne Wagenknecht; James Pankow; Josef Coresh; Frederick L Brancati Journal: N Engl J Med Date: 2010-03-04 Impact factor: 91.245
Authors: N Sarwar; P Gao; S R Kondapally Seshasai; R Gobin; S Kaptoge; E Di Angelantonio; E Ingelsson; D A Lawlor; E Selvin; M Stampfer; C D A Stehouwer; S Lewington; L Pennells; A Thompson; N Sattar; I R White; K K Ray; J Danesh Journal: Lancet Date: 2010-06-26 Impact factor: 202.731
Authors: Walter N Kernan; Catherine M Viscoli; Karen L Furie; Lawrence H Young; Silvio E Inzucchi; Mark Gorman; Peter D Guarino; Anne M Lovejoy; Peter N Peduzzi; Robin Conwit; Lawrence M Brass; Gregory G Schwartz; Harold P Adams; Leo Berger; Antonio Carolei; Wayne Clark; Bruce Coull; Gary A Ford; Dawn Kleindorfer; John R O'Leary; Mark W Parsons; Peter Ringleb; Souvik Sen; J David Spence; David Tanne; David Wang; Toni R Winder Journal: N Engl J Med Date: 2016-02-17 Impact factor: 91.245
Authors: Emanuele Di Angelantonio; Pei Gao; Hassan Khan; Adam S Butterworth; David Wormser; Stephen Kaptoge; Sreenivasa Rao Kondapally Seshasai; Alex Thompson; Nadeem Sarwar; Peter Willeit; Paul M Ridker; Elizabeth L M Barr; Kay-Tee Khaw; Bruce M Psaty; Hermann Brenner; Beverley Balkau; Jacqueline M Dekker; Debbie A Lawlor; Makoto Daimon; Johann Willeit; Inger Njølstad; Aulikki Nissinen; Eric J Brunner; Lewis H Kuller; Jackie F Price; Johan Sundström; Matthew W Knuiman; Edith J M Feskens; W M M Verschuren; Nicholas Wald; Stephan J L Bakker; Peter H Whincup; Ian Ford; Uri Goldbourt; Agustín Gómez-de-la-Cámara; John Gallacher; Leon A Simons; Annika Rosengren; Susan E Sutherland; Cecilia Björkelund; Dan G Blazer; Sylvia Wassertheil-Smoller; Altan Onat; Alejandro Marín Ibañez; Edoardo Casiglia; J Wouter Jukema; Lara M Simpson; Simona Giampaoli; Børge G Nordestgaard; Randi Selmer; Patrik Wennberg; Jussi Kauhanen; Jukka T Salonen; Rachel Dankner; Elizabeth Barrett-Connor; Maryam Kavousi; Vilmundur Gudnason; Denis Evans; Robert B Wallace; Mary Cushman; Ralph B D'Agostino; Jason G Umans; Yutaka Kiyohara; Hidaeki Nakagawa; Shinichi Sato; Richard F Gillum; Aaron R Folsom; Yvonne T van der Schouw; Karel G Moons; Simon J Griffin; Naveed Sattar; Nicholas J Wareham; Elizabeth Selvin; Simon G Thompson; John Danesh Journal: JAMA Date: 2014-03-26 Impact factor: 56.272
Authors: Leigh Perreault; Qing Pan; Emily B Schroeder; Rita R Kalyani; George A Bray; Samuel Dagogo-Jack; Neil H White; Ronald B Goldberg; Steven E Kahn; William C Knowler; Nestoras Mathioudakis; Dana Dabelea Journal: Diabetes Care Date: 2019-07-18 Impact factor: 19.112