THU306 Association Of Prediabetes With Cardiovascular Outcomes Among Veterans With Obesity

Abstract

Abstract Disclosure: J. Pendse: None. J. Mathew: None. S. Maidman: None. K. Mangalick: None. A. Ramachandran: None. E. Siddiqui: None. J.O. Aleman Diaz: None. Introduction: Prediabetes occurs frequently in obesity and is independently associated with increased atherosclerosis in nondiabetic patients. We sought to compare the effects of prediabetes on cardiovascular interventions along the glycemic control spectrum in obesity within the Veterans Health Administration (VHA), the largest US healthcare system. Methods: We conducted a systematic, retrospective review using the VHA Corporate Data Warehouse through the Veterans Administration Informatics and Computing Infrastructure database. We compared patients with obesity and prediabetes (preDM) to patients with obesity and normoglycemia (NG). Inclusion criteria included a body mass index (BMI) ≥ 30 kg/m2, Hemoglobin A1C (HbA1c) < 6.5% between 2000 and 2016. The intervention group included patients with preDM, defined by HbA1c between 5.7% to less than 6.5%, and the control group included patients with NG, defined as HbA1c< 5.7%. The primary endpoint was incidence of coronary revascularization, defined as a composite of percutaneous cardiac intervention (PCI) or coronary artery bypass graft (CABG). Secondary outcomes included PCI, CABG, diagnostic cardiac catheterizations, and mortality. Groups were compared using Pearson’s Chi-squared test or student t-tests when appropriate with alpha set to 0.05, and were assumed to have normal distribution. Results: A total of 137,487 subjects were included in the study, with 91,611 subjects with preDM and 45,876 subjects with NG. The average BMI among the preDM group was 33.8 kg/m2 ± 3.6 and the average BMI among the NG group was 33.4 kg/m2 ± 3.3 (p<0.001). Obesity/preDM subjects had a higher rate of coronary revascularization (6.3%, n=5,749) compared to obesity/NG subjects (3.1%, n=1,408) (p<0.001). From a total of 7,157 revascularized veterans, all-cause mortality rate was increased in preDM subjects (6.6%, n=851) compared to NG subjects (5.8%, n=221) (p<0.001). Obesity/preDM subjects had a higher rate of all-cause mortality (3.9%, n=3607) compared to obesity/NG subjects (2.8%, n= 1273). Also of note, obesity/preDM subjects had higher rates of diagnostic catheterization (11.9%, n=10,858), PCI (5.4%, n=4,913), stent (0.57%, n=528), CABG (1.2%, n=1087) compared with rates in obesity/NG subjects with diagnostic catheterization (7.1%, n=3272), PCI (2.6%, n=1183), stent (0.30%, n=138), and CABG (0.56%, n=258). Evaluating composite cardiovascular outcomes including PCI, stent, and CABG, obesity/preDM subjects had higher rates (6.3%, n=5749) compared with obesity/NG subjects (3.1%, n=1408). Conclusion: In this retrospective study, we have concluded that veterans diagnosed with obesity/preDM had higher rates of composite cardiovascular outcomes, including significantly higher rates of coronary revascularization procedures, overall mortality, and mortality following revascularization compared to veterans with obesity/NG. Presentation: Thursday, June 15, 2023