Abstract MP47: Diabetes, Prediabetes, and Short-Term Cardiovascular Risk and Death in Older Adults

Abstract

Background: Studies in middle-age adults have established prediabetes and diabetes as major cardiovascular disease (CVD) risk factors. Whether these associations persist among older adults is less clear. Methods: Older adults in the Atherosclerosis Risk in Communities (ARIC) Study who attended visit 5 (2013-2015; n = 5,791; ages 66-90) were followed for recurrent global CVD events (fatal or non-fatal myocardial infarction, stroke, and heart failure) and all-cause mortality. We used Cox proportional hazards and negative binomial regression to quantify and compare the independent associations of prediabetes (hemoglobin A1c [A1c]: 5.7-6.3%) and diabetes (prior diagnosis, medication use, or A1c ≥ 6.4%), traditional CVD factors, subclinical CVD (assessed using high sensitivity cardiac troponin [hs-cTnT]), and short-term risk of clinical outcomes in this older population. Results: Over a median follow-up of 4.6 years, there were 5,442 global CVD events (32% with at least one event) and 660 deaths. Diabetes, but not prediabetes, was significantly associated with both outcomes ( Table ). After adjustment for traditional risk factors, diabetes of shorter duration was no longer significantly associated with global CVD; however, diabetes of longer duration, renal disease, and subclinical CVD remained significantly associated with both outcomes. Higher risks of global CVD events and mortality were observed in Blacks compared to Whites. Conclusions: Prediabetes and short-term diabetes were not major independent predictors of short-term CVD events or death in older adults, especially compared to hypertension, kidney disease, long-term diabetes, and subclinical and prevalent CVD. Our results support focusing on these latter risk factors in older adults.