Abstract
This was a prospective, observational study to compare the burden of subclinical atherosclerosis as measured by carotid ultrasonography in a cohort of subjects with prediabetes vs. subjects with normal glucose tolerance (NGT) from a non-urban Mediterranean population. Atherosclerosis was assessed through carotid intima-media thickness (c-IMT), the presence/absence of carotid plaques, and plaque number. Among 550 subjects included, 224 (40.7%) had prediabetes. The mean c-IMT and the prevalence of carotid plaque were significantly higher in the prediabetes group compared to the NGT group (0.72 vs. 0.67 mm, p < 0.001; and 37.9% vs. 19.6%; p < 0.001, respectively). Older age, male gender, and increased systolic blood pressure were positively correlated with c-IMT and were independent predictors of the presence of plaques. In contrast, prediabetes and low-density lipoprotein (LDL)-c were predictors of the presence of plaque (odds ratio [OR] = 1.64; 95% confidence interval [CI] = 1.05–2.57; p = 0.03 and OR = 1.01; 95% CI = 1.00–1.02; p = 0.006, respectively) together with tobacco exposure and the leukocyte count (OR = 1.77; 95% CI = 1.08–2.89; p = 0.023 and OR = 1.20; 95% CI = 1.05–1.38; p = 0.008, respectively). In a non-urban Mediterranean population, prediabetes was associated with established subclinical carotid atherosclerosis. These findings could have implications for the prevention and treatment of CV risk in these subjects before the first symptoms of cardiovascular disease appear.
Highlights
Cardiovascular disease (CVD) is a multifactorial condition that is the result of a complex interaction between genetic predisposition and well-recognized cardiovascular (CV) risk factors such as diabetes mellitus [1]
40.7% patients were diagnosed as having prediabetes (n = 224) and 59.3% (n = 326) normal glucose tolerance (NGT)
Our study reveals that subjects with prediabetes from a non-urban population had an increased carotid intima-media thickness (c-IMT) and prevalence and burden of carotid plaques compared to NGT subjects
Summary
Cardiovascular disease (CVD) is a multifactorial condition that is the result of a complex interaction between genetic predisposition and well-recognized cardiovascular (CV) risk factors such as diabetes mellitus [1]. It is well established that patients with type 2 diabetes mellitus (T2DM) have a two- to four-fold increased risk of atherosclerotic CVD, and they have a poorer prognosis in terms of CV morbidity and mortality than subjects without diabetes [2]. In prediabetes, which is not a clinical entity per se but an intermediate metabolic state between normoglycemia and diabetes, there is an increased risk of developing overt T2DM and CVD [3]. This is mainly because it is frequently accompanied by traditional CV risk factors such as obesity, dyslipidemia, and hypertension [4]. Since the diagnosis of prediabetes and T2DM is often delayed, macrovascular complications may already be present at the moment of the diagnosis of diabetes [6]
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