医学
糖尿病前期
狼牙棒
内科学
危险系数
心肌梗塞
冠状动脉疾病
前瞻性队列研究
血糖性
队列
临床终点
糖尿病
置信区间
心脏病学
2型糖尿病
经皮冠状动脉介入治疗
内分泌学
临床试验
胰岛素
作者
Kongyong Cui,Daqiang Yin,Weihua Song,Hongjian Wang,Cheng‐Gang Zhu,Lei Feng,Jianjun Li,Lei Jia,Yonggang Lu,Rui Zhang,Boqun Shi,Yanjun Song,Rui Fu,Kefei Dou
标识
DOI:10.1093/eurjpc/zwad095
摘要
To evaluate the impact of prediabetes identified by different glycemic thresholds (according to ADA or WHO/IEC criteria) and diagnostic tests (fasting plasma glucose [FPG] or hemoglobin A1c [HbA1c]) on clinical outcomes in patients with stable coronary artery disease (CAD).In this prospective cohort study, we consecutively enrolled 4088 stable CAD non-diabetic patients with a median follow-up period of 3.2 years. Prediabetes was defined according to ADA criteria as FPG 5.6∼6.9 mmol/L and/or HbA1c 5.7∼6.4%, and WHO/IEC criteria as FPG 6.1∼6.9 mmol/L and/or HbA1c 6.0∼6.4%. The primary endpoint was major adverse cardiovascular event (MACE), including all-cause death, myocardial infarction, or stroke. The prevalence of prediabetes defined according to ADA criteria (67%) was double that of WHO/IEC criteria (34%). Compared with patients with normoglycaemia, those with WHO/IEC-defined prediabetes were significantly associated with higher risk of MACE [adjusted hazard ratio (HR) 1.50, 95% confidence interval (CI) 1.10-2.06], mainly driven by the higher incidence of events in individuals with HbA1c-defined prediabetes. However, this difference was not found in patients with ADA-defined prediabetes and normoglycaemia (adjusted HR 1.17, 95% CI 0.81-1.68). Although FPG was not associated with cardiovascular events, HbA1c improved the risk prediction for MACE in a model of traditional risk factors. Furthermore, the optimal cutoff value of HbA1c for predicting MACE was 5.85%, which was close to the threshold recommended by IEC.This study supports the use of WHO/IEC criteria for the identification of prediabetes in stable CAD patients. Haemoglobin A1c, rather than FPG, should be considered as a useful marker for risk stratification in this population.Not applicable.This study, for the first time, evaluated the prognostic effect of prediabetes identified by different glycaemic thresholds (ADA or WHO/IEC criteria) and diagnostic tests (FPG or HbA1c) in individuals with stable CAD. The results of this study support the identification of individuals with prediabetes using WHO/IEC criteria in stable, angiography-proven CAD patients. Haemoglobin A1c, rather than FPG, should be considered as a useful marker for risk stratification and the optimal cutoff value of HbA1c for predicting MACE was 5.85%, which was close to the threshold of 6.0% recommended by IEC.
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