Prediabetes May Be an Independent Risk Factor for MI

Even prediabetes seemed to spell bad news for heart health, according to a national inpatient sample study.

Prediabetes -- defined as an Hba1c between 5.7% to 6.4% -- among hospitalized patients was associated with 41% higher odds for myocardial infarction (MI, OR 1.41, 95% CI 1.35-1.47) in a general model, reported Geethika Thota, MBBS, of Saint Peter University Hospital/Rutgers Robert Wood Johnson Hospital in New Brunswick, New Jersey.

And in a model adjusted for multiple factors including age, sex, race, family history of MI, dyslipidemia, hypertension, diabetes, nicotine dependence, and obesity status, presence of prediabetes was still significantly associated with a higher chance of experiencing MI (OR 1.25, 95% CI 1.20-1.31).

"Prediabetes stood as an independent risk factor for myocardial infarction, despite adjusting for all the well-established risk factors," Thota explained in a presentation at ENDO 2022, the Endocrine Society annual meeting. "Prediabetes is real. Don't let the 'pre' fool anyone."

On top of that, prediabetes also was tied to higher odds for undergoing percutaneous coronary intervention (OR 1.45, 95% CI 1.37-1.53) and higher odds of getting coronary artery bypass grafting (OR 1.95, 95% CI 1.77-2.16) in adjusted models.

Thota pointed out that these findings suggest there is a high burden of macrovascular coronary artery disease associated with prediabetes. "With our study, we would like to reinforce that it's a wake-up call for the clinicians, as well as for patients," Thota explained. "[We need to] shift the focus to prevent prediabetes and not just diabetes."

"Our findings would also reinforce the importance of early recognition through screening and early intervention to aggressively manage the cardiovascular risk factors to prevent myocardial infarction," she said.

Thota suggested following recommendations from the American Diabetes Association (ADA) 2022 "Standards of Medical Care in Diabetes" guidelines, and to screen all patients over age 35 for prediabetes. Additionally, the ADA guidelines recommend screening all people with HIV, all women with gestational diabetes, and adults with overweight or obesity (BMI over 25 or over 23 for Asian Americans) with a specific underlying risk factor.

"Early intervention is the key," Thota said, highlighting that the most important interventions include diet, physical activity, and lifestyle modifications, and adding that "Metformin and GLP-1 receptor agonists can also be used."

Thota and colleagues drew upon 1,794,149 hospitalizations at teaching hospitals for patients admitted with a primary or secondary diagnosis of acute MI. Data was collected between 2016 to 2018. Among these patients, 1% had prediabetes. This represented a sample of 330,814 patients with prediabetes.

Study limitations included the retrospective design and the fact that prediabetes can often be missed during ICD coding, although Thota noted that teaching hospitals tend to code a bit better when it comes to this.

She also pointed out that the majority of people with prediabetes aren't in the hospital, but rather in the community and clinics. She cautioned that the inpatient study-sample represented one subset of patients with prediabetes.

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