Prediabetes and Risk for Cardiovascular Disease by Hypertension Status in Black Adults: The Jackson Heart Study

Abstract

Recent studies have suggested that prediabetes is associated with an increased risk for cardiovascular disease (CVD) only among individuals with concomitant hypertension. RESEARCH DESIGN AND METHODS We analyzed the association between prediabetes and CVD by hypertension status among 3,313 black adults in the Jackson Heart Study (JHS) without diabetes or a history of CVD at baseline (2000-2004). Prediabetes was defined as fasting plasma glucose between 100 and 125 mg/dL or hemoglobin A 1c between 5.7 and 6.4% (39 and 46 mmol/mol). Hypertension was defined as systolic/diastolic blood pressure ‡140/90 mmHg and/or self-reported antihypertensive medication use. Participants were followed for incident CVD events and all-cause mortality through 31 December 2014. RESULTS Overall, 35% of JHS participants did not have prediabetes or hypertension, 18% had prediabetes alone, 22% had hypertension alone, and 25% had both prediabetes and hypertension. Compared with participants without either condition, the multivariableadjusted hazard ratios for CVD events among participants with prediabetes alone, hypertension alone, and both prediabetes and hypertension were 0.86 (95% CI 0.51, 1.45), 2.09 (1.39, 3.14), and 1.93 (1.28, 2.90), respectively. Among participants with and without hypertension, there was no association between prediabetes and an increased risk for CVD (0.78 [0.46, 1.34] and 0.94 [0.70, 1.26], respectively). No association was present between prediabetes and all-cause mortality among participants with or without hypertension. CONCLUSIONS Regardless of hypertension status, prediabetes was not associated with an increased risk for CVD or all-cause mortality in this cohort of black adults. Prediabetes is an intermediate glycemic state between normal glycemia and diabetes that is characterized by impaired fasting glucose (100-125 mg/dL), impaired glucose tolerance (2-h plasma glucose concentration 140-199 mg/dL after an oral glucose challenge), or a hemoglobin A 1c (HbA 1c) between 5.7 and 6.4% (39 and 46 mmol/mol) (1,2). Approximately 84.1 million U.S. adults $18 years of age had prediabetes in 2015 (3). A higher proportion of non-Hispanic blacks in the U.S. have prediabetes compared with non-Hispanic whites and Hispanics (1).

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

“…The studies included in the previous meta-analysis were from the general population, so the health risk for prediabetes in patients with established atherosclerotic cardiovascular disease was not established. In recent years, many studies exploring the associations between prediabetes and the risk of cardiovascular disease and mortality have been published 7891011121314. On their own, most of the studies had limited power to draw solid conclusions, however, and their results have been debated.…”

Cardiometabolic risk factors correlated with the incidence of dysglycaemia in a Brazilian normoglycaemic sample: the Baependi Heart Study cohort

“…5 Department of Statistics, Pontifícia Universidad Católica de Chile, Santiago, Chile. 6 Framingham Heart Study, Framingham, USA. 7 Department of Biostatistics, Boston University, Boston, USA.…”

“…The relationship between prediabetic dysglycaemia and other associated risk factors has been studied across the world [1,6,7], but there is no consensus, since each population has particularities regarding environmental, genetic and clinical factors involved. The identification of the most important conditions related to the incidence of prediabetic dysglycaemia is needed to allow the development of specific strategies to prevent the modifiable risk factors.…”

<p>Systolic Blood Pressure, Cardiovascular Mortality, and All-Cause Mortality in Normoglycemia, Prediabetes, and Diabetes</p>

“…Patients with established hypertension and diabetes mellitus (DM) have a 4-fold increased risk for the development of cardiovascular diseases (CVD) and substantially higher risk of CVD death and all-cause mortality. 1,2 Whether prediabetes (Pre-DM) alone is associated with adverse cardiovascular outcomes remains uncertain, 3,4 but findings from several longitudinal studies and meta-analyses have suggested that patients with Pre-DM have 3-12 times higher risk of incident DM than in the general population. [5][6][7][8] Besides, with the combination of hypertension, Pre-DM could accelerate the development of DM and further significantly increase CVD risk.…”