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Prediabetes does not increase risk in patients with coronary artery disease (ARTEMIS)
Clinical Question
In patients with coronary artery disease, does prediabetes increase the risk of death or major cardiac event?
Bottom line
Prediabetes does not significantly increase the risk of major cardiac events or death as compared with normal glycemic levels. Over 6 years of follow-up, patients with impaired glucose tolerance or impaired fasting glucose were at lower risk of death or subsequent cardiac event than patients with type 2 diabetes, but were not at increased risk as compared with patients with normal glycemic levels. 1b
Reference
Study design: Cohort (prospective)
Funding: Government
Setting: Outpatient (any)
Synopsis
Investigators enrolled 1948 patients with coronary artery disease 3 to 6 months following revascularization or at the start of medical therapy. All patients had an oral glucose tolerance test to determine their diabetes status. During a mean follow-up of 6.3 years, cardiac mortality was 8.2% for those with type 2 diabetes, 3.8% for patients with impaired glucose tolerance, 2.9% for patients with impaired fasting glucose, and 2.6% for normoglycemic patients. The mortality rate was significantly lower in patients with normoglycemia and impaired fasting glucose than in patients with type 2 diabetes. Cardiac death, major cardiac events, and all-cause mortality rates were not different among patients with impaired glucose tolerance, impaired fasting glucose, or normal glycemic status.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA