Ideal Cardiovascular Health Metrics and Major Cardiovascular Events in Patients With Prediabetes and Diabetes

Wang, Tiange; Lu, Jieli; Su, Qing; Chen, Yuhong; Bi, Yufang; Mu, Yiming; Chen, Lulu; Hu, Ruying; Tang, Xulei; Yu, Xuefeng; Li, Mian; Xu, Min; Xu, Yu; Zhao, Zhiyun; Yan, Li; Qin, Guijun; Wan, Qin; Chen, Gang; Dai, Meng; Zhang, Di; Gao, Zhengnan; Wang, Guixia; Shen, Feixia; Luo, Zuojie; Qin, Yingfen; Chen, Li; Huo, Yanan; Li, Qiang; Ye, Zhen; Zhang, Yinfei; Liu, Chao; Wang, Youmin; Wu, Shengli; Yang, Tao; Deng, Hongkui; Li, Donghui; Lai, Shenghan; Bloomgarden, Zachary T.; Shi, Lixin; Ning, Guang; Zhao, Jiajun; Wang, Weiqing

doi:10.1001/jamacardio.2019.2499

Cited by 99 publications

(94 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The studies included in the previous meta-analysis were from the general population, so the health risk for prediabetes in patients with established atherosclerotic cardiovascular disease was not established. In recent years, many studies exploring the associations between prediabetes and the risk of cardiovascular disease and mortality have been published 7891011121314. On their own, most of the studies had limited power to draw solid conclusions, however, and their results have been debated.…”

Section: Introductionmentioning

confidence: 99%

“…In recent years, many studies exploring the associations between prediabetes and the risk of cardiovascular disease and mortality have been published. 7 8 9 10 11 12 13 14 On their own, most of the studies had limited power to draw solid conclusions, however, and their results have been debated. A recent contentious report in Science defined prediabetes as a “dubious diagnosis” because of the inconsistent association of prediabetes with cardiovascular disease and mortality.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Association between prediabetes and risk of all cause mortality and cardiovascular disease: updated meta-analysis

Cai

Zhang

et al. 2020

BMJ

429

311

View full text Add to dashboard Cite

Objective To evaluate the associations between prediabetes and the risk of all cause mortality and incident cardiovascular disease in the general population and in patients with a history of atherosclerotic cardiovascular disease. Design Updated meta-analysis. Data sources Electronic databases (PubMed, Embase, and Google Scholar) up to 25 April 2020. Review methods Prospective cohort studies or post hoc analysis of clinical trials were included for analysis if they reported adjusted relative risks, odds ratios, or hazard ratios of all cause mortality or cardiovascular disease for prediabetes compared with normoglycaemia. Data were extracted independently by two investigators. Random effects models were used to calculate the relative risks and 95% confidence intervals. The primary outcomes were all cause mortality and composite cardiovascular disease. The secondary outcomes were the risk of coronary heart disease and stroke. Results A total of 129 studies were included, involving 10 069 955 individuals for analysis. In the general population, prediabetes was associated with an increased risk of all cause mortality (relative risk 1.13, 95% confidence interval 1.10 to 1.17), composite cardiovascular disease (1.15, 1.11 to 1.18), coronary heart disease (1.16, 1.11 to 1.21), and stroke (1.14, 1.08 to 1.20) in a median follow-up time of 9.8 years. Compared with normoglycaemia, the absolute risk difference in prediabetes for all cause mortality, composite cardiovascular disease, coronary heart disease, and stroke was 7.36 (95% confidence interval 9.59 to 12.51), 8.75 (6.41 to 10.49), 6.59 (4.53 to 8.65), and 3.68 (2.10 to 5.26) per 10 000 person years, respectively. Impaired glucose tolerance carried a higher risk of all cause mortality, coronary heart disease, and stroke than impaired fasting glucose. In patients with atherosclerotic cardiovascular disease, prediabetes was associated with an increased risk of all cause mortality (relative risk 1.36, 95% confidence interval 1.21 to 1.54), composite cardiovascular disease (1.37, 1.23 to 1.53), and coronary heart disease (1.15, 1.02 to 1.29) in a median follow-up time of 3.2 years, but no difference was seen for the risk of stroke (1.05, 0.81 to 1.36). Compared with normoglycaemia, in patients with atherosclerotic cardiovascular disease, the absolute risk difference in prediabetes for all cause mortality, composite cardiovascular disease, coronary heart disease, and stroke was 66.19 (95% confidence interval 38.60 to 99.25), 189.77 (117.97 to 271.84), 40.62 (5.42 to 78.53), and 8.54 (32.43 to 61.45) per 10 000 person years, respectively. No significant heterogeneity was found for the risk of all outcomes seen for the different definitions of prediabetes in patients with atherosclerotic cardiovascular disease (all P>0.10). Conclusions Results indicated that prediabetes was associated with an increased risk of all cause mortality and cardiovascular disease in the general population and in patients with atherosclerotic cardiovascular disease. Screening and appropriate management of prediabetes might contribute to primary and secondary prevention of cardiovascular disease.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association between prediabetes and risk of all cause mortality and cardiovascular disease: updated meta-analysis

Cai

Zhang

et al. 2020

BMJ

429

311

View full text Add to dashboard Cite

show abstract

“…In addition, hypertension is present in more than half of type 2 diabetic patients and contributes significantly to macro- and micro-vascular complications [5]. The development of T2DM is often asymptomatic and subclinical for a long period, and before diagnosis of T2DM, individuals can reside in the high-risk state of prediabetes, defined as impaired fasting glucose or impaired glucose tolerance [6, 7]. Recently, the prevalence of hypertension and T2DM is increasing in many Asian countries, with a number of countries with blood pressure (BP) and glucose above the global average [7–12].…”

Section: Introductionmentioning

confidence: 99%

“…The development of T2DM is often asymptomatic and subclinical for a long period, and before diagnosis of T2DM, individuals can reside in the high-risk state of prediabetes, defined as impaired fasting glucose or impaired glucose tolerance [6, 7]. Recently, the prevalence of hypertension and T2DM is increasing in many Asian countries, with a number of countries with blood pressure (BP) and glucose above the global average [7–12]. The Chinese National Report of Cardiovascular Disease 2018 pointed out that the prevalence of hypertension and diabetes reaches 23.2% and 10.9%, respectively, leading to an estimate of about 290 million of adult people suffering from cardiovascular disease in China [9].…”

Section: Introductionmentioning

confidence: 99%

Searching for optimal blood pressure targets in type 2 diabetic patients with coronary artery disease

Shen

Dai

Wang

et al. 2019

Cardiovasc Diabetol

View full text Add to dashboard Cite

BackgroundControversies exist regarding the optimal blood pressure (BP) level that is safe and provides cardiovascular protection in patients with type 2 diabetes mellitus (T2DM) and coexistent coronary artery disease. Several new glucose-lowering agents have been found to lower BP as well, making the interaction between BP and T2DM even more complex.MethodsWith the reference to recent literature, this review article describes the potential mechanisms of increased risk of hypertension in T2DM and outlines the possible optimal BP levels based upon recommendations on the management of hypertension by the current guidelines, in combination with our research findings, for type 2 diabetic patients with coronary artery disease.ResultsThe development of hypertension in T2DM involves multiple processes, including enhanced sympathetic output, inappropriate activation of renin-angiotensin- aldosterone system, endothelial dysfunction induced through insulin resistance, and abnormal sodium handling by the kidney. Both AGE-RAGE axis and adipokine dysregulation activate intracellular signaling pathways, increase oxidative stress, and aggravate vascular inflammation. Pancreatic β-cell specific microRNAs are implicated in gene expression and diabetic complications. Non-pharmacological intervention with lifestyle changes improves BP control, and anti-hypertensive medications with ACEI/ARB, calcium antagonists, β-blockers, diuretics and new hypoglycemic agent SGLT2 inhibitors are effective to decrease mortality and prevent major adverse cardiovascular events. For hypertensive patients with T2DM and stable coronary artery disease, control of BP < 130/80 mmHg but not < 120/70 mmHg is reasonable, whereas for those with chronic total occlusion or acute coronary syndromes, an ideal BP target may be somewhat higher (< 140/90 mmHg). Caution is advised with aggressive lowering of diastolic BP to a critical threshold (< 60 mmHg).ConclusionsHypertension and T2DM share certain similar aspects of pathophysiology, and BP control should be individualized to minimize adverse events and maximize benefits especially for patients with T2DM and coronary artery disease.

show abstract

“…In a recent large scale nationwide prospective cohort study, participants with prediabetes or diabetes who had five or more ICVHMs (ideal cardiovascular health metrics) exhibited lower or no significant excess risk of CVD events compared with those with normal glucose regulation. Compared with 1 ideal CVH metric or none, 5 or more ideal metrics were associated with 58% and 61% lower CVD risks among participants with prediabetes and diabetes, respectively [23].…”

mentioning

confidence: 97%

Effect of Lifestyle Changes after Percutaneous Coronary Intervention on Revascularization

Wang

Xian

Chen

et al. 2020

BioMed Research International

View full text Add to dashboard Cite

Objective. Whether optimal cardiovascular health metrics may reduce the risk of cardiovascular events in secondary prevention is uncertain. The study was conducted to evaluate the influence of lifestyle changes on clinical outcomes among the subjects underwent percutaneous coronary intervention (PCI). Methods. The study group consists of 17,099 consecutive PCI patients. We recorded data on subject lifestyle behavior changes after their procedure. Patients were categorized as ideal, intermediate, or poor CV health according to a modified Life’s Simple 7 score (on body mass, smoking, physical activity, diet, cholesterol, blood pressure, and glucose). Multivariable COX regression was used to evaluate the association between CV health and revascularization event. We also tested the impact of cumulative cardiovascular health score on reoccurrence of cardiovascular event. Results. During a 3-year median follow-up, 1,583 revascularization events were identified. The observed revascularization rate was 8.0%, 9.3%, and 10.6% in the group of patients with optimal (a modified Life’s Simple 7 score of 11–14), average (score = 9 or 10), or inadequate (less or equal than 8) CV health, respectively. After multivariable analysis, the adjusted hazard ratios were 0.83 (95% CI: 0.73–0.94) and 0.89 (95% CI: 0.79–0.99) for patients with optimal and average lifestyle changes comparing with the inadequate tertile (P for trend = 0.003). In addition, each unit increase in above metrics was associated with a decrease risk of revascularization (HR, 0.96; 95% confidence interval, 0.93–0.98; P<0.001). Conclusion. Ideal CV health related to lower incidence of cardiovascular events, even after the percutaneous coronary intervention. Revascularization can be reduced by lifestyle changes. The cardiovascular health metrics could be extrapolated to secondary prevention and need for further validation.

show abstract

Ideal Cardiovascular Health Metrics and Major Cardiovascular Events in Patients With Prediabetes and Diabetes

Cited by 99 publications

References 30 publications

Association between prediabetes and risk of all cause mortality and cardiovascular disease: updated meta-analysis

Association between prediabetes and risk of all cause mortality and cardiovascular disease: updated meta-analysis

Searching for optimal blood pressure targets in type 2 diabetic patients with coronary artery disease

Effect of Lifestyle Changes after Percutaneous Coronary Intervention on Revascularization

Contact Info

Product

Resources

About