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Curr Diab Rep. 2017 Sep;17(9):77. doi: 10.1007/s11892-017-0899-7.

Can Cardiovascular Epidemiology and Clinical Trials Close the Risk Management Gap Between Diabetes and Prediabetes?

Author information

1
University of Colorado Anschutz Medical Campus, mailstop F8106, P.O. Box 6511, Aurora, CO, 80045, USA. Leigh.perreault@ucdenver.edu.
2
Steno Diabetes Center Copenhagen, Gentofte, Denmark.
3
Centers for Disease Control and Prevention, Atlanta, GA, USA.

Abstract

PURPOSE OF REVIEW:

We reviewed published literature to determine the relationship between A1c and cardiovascular disease (CVD) and summarize the need and implications for CVD risk reduction with interventions, focusing in the prediabetic A1c range (<6.5%).

RECENT FINDINGS:

Strong evidence supports a continuous relationship between A1c and CVD-even below the current levels of A1c-defined prediabetes and after adjustment for known risk factors for CVD. Clinical trials have demonstrated a reduction in CV morbidity and/or mortality when interventions are invoked in the prediabetic A1c range. Guidelines advocating CV risk factor management in prediabetes have not been widely adopted, subsequently leading to comparable coronary heart disease risk between people with prediabetes (HR = 1.9, 95% CI 1.7-2.1 vs normoglycemia) and diabetes itself (HR=2.0, 95% CI 1.8-2.2 vs no diabetes). This review highlights the missed opportunity to utilize multiple risk factor interventions to reduce CVD in high-risk people with prediabetes.

KEYWORDS:

A1c threshold; CVD; Macrovascular disease; Review

PMID:
28766246
DOI:
10.1007/s11892-017-0899-7
[Indexed for MEDLINE]

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