Pre-hypertension, pre-diabetes or both: which is best at predicting cardiovascular events in the long term?

Abstract

The present study aimed to assess the value of pre-diabetes and pre-hypertension in predicting cardiovascular events. A population-based, cross-sectional survey was conducted, representing a large sample of the general Iranian population aged 35 years and older from the Isfahan Province and determined using a random, multistage cluster-sampling 10-year cohort. The five end points considered as study outcome were unstable angina (UA), acute occurrence of myocardial infarction (MI), sudden cardiac death (SCD), brain stroke and cardiovascular disease (CVD). Of the 6323 subjects scheduled for assessment of diabetes state 617 were diabetics and 712 were pre-diabetic. In addition, of these subjects, 1754 had hypertension and 2500 had pre-hypertension. Analysing only pre-hypertension, pre-diabetes and its combination and adjusted for gender and age variables, pre-hypertension and pre-diabetes status together, could only effectively predict occurrence of MI (hazard ratio (HR)=3.21, 95% confidence interval (CI): 1.06-9.76, P=0.04). In the same COX regression models, pre-hypertension status could predict UA and CVD occurrence (HR=2.94, 95% CI: 1.68-5.14, P<0.001 and HR=1.74, 95% CI: 1.23-2.47, P=0.002, respectively). However, pre-diabetes status could not predict any of these events after adjustment for gender and age. Our data provide valuable evidence of the triggering role of pre-hypertension and pre-diabetes together, on appearance and progression of MI even in healthy individuals and the significant predicting value of pre-hypertension on the occurrence of UA and CVD. In this regard, the value of pre-hypertension and pre-diabetes together, and the pre-hypertension state alone, are clearly superior to pre-diabetes state alone in predicting cardiovascular events.

Association between anthropometric indicators of adiposity and hypertension in a Brazilian population: Baependi Heart Study

“…Besides that, it is expected the higher proportion of hypertension among diabetic individuals (15.1%) than normotensive groups (2.9%). These results are in agreement with the literature, and the relationship among obesity, hyperlipidemia, diabetes, and high levels of BP has been shown in several studies [5,6,8,9,11,12,17,21–23]. …”

“…In the last years, epidemiological studies have shown that higher levels of BP are widely associated with increased risk of fatal and nonfatal cardiovascular events [2–5]. Hypertension is a highly prevalent disease, affects about 1.13 billion adults worldwide [6], and is associated with several cardiometabolic conditions such as hyperlipidemia, atherosclerosis, inflammation, insulin resistance, diabetes mellitus, and obesity [4,5,7–10]. …”

Comparison of the Mediterranean diet and the Dietary Approach Stop Hypertension in reducing the risk of 10-year fatal and non-fatal CVD events in healthy adults: the ATTICA Study (2002–2012)

“…The current study confirms previous reports demonstrating that adherence to the DASH diet is not associated with diminished rates of CVD incidence (4) and/or mortality (4,40) . These findings have been primarily confirmed not only in Mediterranean populations but also in Western populations which are not indigenous to the Mediterranean region.…”

“…CVD constitute one of the prevailing causes of morbidity and mortality in developed countries (1,2) . Several nonmodifiable and modifiable demographic, lifestyle and clinical factors (including obesity (especially abdominal obesity), dyslipidaemia, the metabolic syndrome and/or type 2 diabetes mellitus) (3,4) alike are implicated in the onset, further progression and, ultimately, attributable mortality of CVD (5) . Although not constituting the initial triggers in all cases, both the aforementioned non-modifiable and modifiable factors are hypothesised to be implicated via a complex interplay in disease onset and propagation through the positive feedback mechanisms of the dysregulated renin-angiotensin-aldosterone system, leading to the activation of an inflammatory cascade and lipid dysregulation (6) .…”

Prediabetes and risk for all-cause and cardiovascular mortality based on hypertension status

“…These findings are consistent with those of some of the previous studies. A cohort study from Iran showed that prediabetes status did not predict any CVD events after adjusting for sex and age (17). The Innovation to Reduce Cardiovascular Complications of Diabetes at the Intersection Study (ARTEMIS) showed that among patients with coronary artery disease, prediabetes was not associated with the risk of cardiovascular and all-cause mortality (18).…”