Abstract
Introduction: Cardiovascular disease (CVD) is often preceded by prediabetes (pre-DM) and/or prehypertension (pre-HT), but few studies have investigated the effect of concurrent pre-DM and pre-HT on cardiovascular risk. Hypothesis: We assessed the hypothesis that concurrent pre-DM and pre-HT increases the risk of CVD. Furthermore, we examined if the estimated cardiovascular risk differs with sex and with the definition of pre-DM. Methods: In 2002-2005, 2816 randomly selected individuals from two Swedish municipalities were enrolled in a health survey. The participants’ cardiometabolic profiles, including blood pressure (BP) and glucose tolerance, were examined. Individuals with diabetes mellitus and/or hypertension were excluded, leaving 2330 persons for analyses. Out of these, 150 had co-existing pre-DM (IFG and/or IGT) and pre-HT (WHO 2013 criteria), while 1250 had simultaneous normal glucose tolerance (NGT) and optimal BP (< 120/80 mmHg). Outcomes were assessed in 2011 using national Swedish registers. Hazard ratios (HR) for CVD were calculated for pre-DM, pre-HT and pre-HT combined with pre-DM, all versus NGT/optimal BP. Analyses were adjusted for age, BMI, sex, smoking and earlier CVD. Results: A total of 80 CVD events occurred during 8.1±0.9 years of follow-up. The unadjusted HR for CVD for combined pre-DM/pre-HT was 22.5. The association was attenuated after adjustments but persisted in the full model, see Figure 1. A test for interaction between combined pre-DM/pre-HT and sex on the outcome of CVD was non-significant (p = 0.6). IFG/pre-HT predicted CVD in all adjustment models (HR 3.2, p = 0.005) while IGT/pre-HT did not. Conclusions: Combined pre-DM and pre-HT substantially increases the risk of CVD. Those with pre-DM defined by IFG might be at particularly high risk, while the risk is likely the same in both sexes. Intensified treatment strategies should be considered in those with concomitant pre-DM and pre-HT.
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