Cardiovascular Risk Profile in Subjects With Prediabetes and New-Onset Type 2 Diabetes Identified by HbA1c According to American Diabetes Association Criteria

Abstract

OBJECTIVEWe investigated the cardiovascular risk profile in subjects with prediabetes and new-onset type 2 diabetes identified by glycated hemoglobin A 1c (HbA 1c ) according to the new American Diabetes Association criteria. RESEARCH DESIGN AND METHODSArterial stiffness, intima-media thickness (IMT), soluble receptor for advanced glycation end products (sRAGEs), and oral glucose tolerance test (OGTT) were evaluated in 274 subjects without a previous history of diabetes. The subjects were stratified into three groups according to the HbA 1c levels. RESULTSThe subjects with prediabetes (n = 117, HbA 1c 5.7-6.4% [39-46 mmol/mol]) showed a higher augmentation (Aug), augmentation index (AugI), and IMT compared with those with lower HbA 1c ; however, these values were similar to those of subjects with HbA 1c >6.5% (48 mmol/mol). When we further analyzed the subjects with prediabetes but included only subjects with normal glucose tolerance (NT) in the analysis, AugI and IMT still remained significantly higher than their levels in control subjects with HbA 1c <5.7% (39 mmol/mol). After multiple regression analyses including several cardiovascular risk factors, only HbA 1c , age, and sRAGE were significantly correlated with the IMT, whereas age and 1-h postload glucose were the major determinants of AugI. CONCLUSIONSOur data show that subjects with prediabetes according to HbA 1c , but with both NT according to the OGTT and normal fasting glycemia, have an altered IMT and AugI. These data suggest that a simple, reproducible, and less expensive marker such as HbA 1c may be better able to identify prediabetic subjects at high cardiovascular risk compared with fasting glycemia or OGTT alone.

Comparing HbA1c, fasting and 2-h plasma glucose for screening for abnormal glucose regulation in patients undergoing coronary angiography

“…Furthermore, HbA 1c is used to guide treatment for patients with AGR [6], has been adopted for the diagnosis of AGR [5,6], is associated with risk of diabetes complications [7][8][9][10] as well as cardiovascular risk and mortality in angiographic patients without known diabetes [26][27][28][29][30][31]. Our data, along with the aforementioned evidence, suggest that testing for HbA 1c may be considered as an alternative to OGTT for screening for AGR in patients undergoing CAG.…”

“…However, patients with prediabetes, defined by HbA 1c 39-47 mmol/ mol (5.7%-6.4%), had been associated with advanced coronary atherosclerosis, as compared with patients with HbA 1c < 39 mmol/mol (5.7%) [26]. Similar condition was noted even in patients with normal OGTT [27]. Moreover, HbA 1c has been associated with cardiovascular mortality in patients without known diabetes who were admitted for CAG [28][29][30][31].…”

Evaluation of HbA1c as a prognostic biomarker of cardiovascular events and mortality in nondiabetic patients: Methodological considerations

“…Di Pino et al recently showed that HbA1c was correlated with carotid intima-media thickness (CIMT) in prediabetic patients (n ¼ 117, HbA1c 5.7e6.4%) with normal glucose tolerance [18]. In accordance, at the prediabetes stage, many other studies have highlighted the positive association of HbA1c with CIMT [19e22], echogenic plaque [23] and the progression of coronary artery calcification [24].…”

Glycated hemoglobin and long-term prognosis in patients with suspected stable angina pectoris without diabetes mellitus: A prospective cohort study

“…Individuals with prediabetes were found to have increased intima media thickness of the carotids, an early marker of atherosclerosis [34]. Pre-diabetes has also been associated with risk of diabetes development as well as future microvascular, and macrovascular complications [5].…”