The risk of severe coronary artery disease in prediabetes among the hypertensions --UPPDATE STUDY

Abstract

Abstract Backgrounds and Objectives Hypertension and type 2 diabetes (DM) have become the major public health problems around the world and the concurrence of both diseases leads to more than triple risks developing ASCVD. However, in addition to type 2 diabetes, the diagnosis and treatment of prediabetes (preDM) status acquires more attention in these years. Among these issues, the risks of severe coronary artery disease in prediabetes concurrent with hypertension remains unknown. We sought to evaluate the association of prediabetes and severe coronary artery disease in hypertensions and to propose treatment suggestions using UPPDATE study data. Methods The national cross-sectional study-UPPDATE comprised of 8548 eligible hypertension subjects from 36 cities in China during 2017 to 2019. After consent form assigned, all enrolled hypertensives would undergo a clinical survey and clinical assessment, patients were also required to provide biomedical reports within one-year from his/her visit to outpatient department. Patients with severe coronary stenosis was defined as more than 70% stenosis in more than one coronary artery and underwent percutaneous coronary intervention (PCI). Diagnosis of preDM was based on patients’ HA1bc level ranging from 5.7% to 6.4%. Stata 13.0 was used for statistical analysis. Results Among 8548 hypertensives, 20.38% were diagnosed with diabetes and treated on hypoglycemic therapy,19.2% with HA1bc recorded (1658) can be classified into preDM according to previous definition. 1.76% of 4268 patients who reported ASCVD history had PCI before and 1123 of them provide HA1bc data within one-year from visit. Compared with patients without diabetes, preDM(Odds ratio 6.27, p=0.09 (95%CI 0.81-52.82)) and DM(Odds ratio 5.72, p=0.12 (95%CI 0.62-51.14)) showed significant association with severe coronary artery disease with PCI treatment. 63% preDM and 73% DM patients were undergoing anti-lipid therapy (p<0.05) and LDL-C level was 2.81±0.69mmol/L and 2.79±0.51mmol/L respectively (p=0.82). In multivariate regression analysis, systolic and diastolic blood pressure greater than 140mmHg and 80mmHg had higher risks of PCI treatment in preDM patients compared with the hypertensives without DM. Conclusion Compared with patients without diabetes, hypertension patients with preDM were associated with higher risks of severe coronary artery disease. Systolic and diastolic blood pressure should be controlled more strictly in preDM patients with hypertension to prevent severe coronary artery disease.