Individuals with impaired fasting glucose levels – often called prediabetics – appear to have similar cardiovascular risk factors as patients with diabetes, researchers reported here.

In the study, about 36% of patients with impaired fasting glucose had coronary artery disease compared with 42% of patients with diabetes and 21% of patients with normal blood glucose said Harith Al-Shuwaykh, MD, a resident in internal medicine at Crittenton Hospital Medical Center, Wayne State University, Detroit.

Those findings, which were based on a review of 86 patients who underwent elective percutaneous coronary intervention, were presented at the annual meeting of the American Association of Clinical Endocrinologists.

Likewise 37% of patients with impaired fasting glucose had hyperlipidemia compared with 38% of patients with diabetes and 24% of patients with normal blood glucose.

Al-Shuwaykh told MedPage Today the results indicate that early intervention among the prediabetics may be warranted.

“It is recommended to identify and treat impaired fasting glucose patients early since impaired fasting glucose patients’ distribution in coronary artery disease is comparable to diabetes mellitus,” he said at his poster presentation. He noted that both impaired fasting glucose patients and diabetes patients had nearly double the distribution of hypertension and High cholesterol when compared with normal fasting glucose patients.

He said his results also suggest a need to screen patients with a family history of coronary artery diseases for impaired fasting glucose and diabetes since 40% of the patients with impaired fasting glucose has a family history of heart disease and 33% of those with diabetes had a family history of heart disease.

“In our study we tried to find the impact and contribution of impaired fasting glucose as a risk factor for coronary artery disease in a population of patients who already have coronary disease,” Al-Shuwaykh explained. “We found that a large percentage of these people do have diabetes but the people with impaired glucose levels have similar risk profiles.”

The chart review revealed that 19 of the individuals had normal fasting glucose levels, that is fasting blood glues below 100 mg/dL; 30 patients had impaired fasting blood glucose levels (100-125 mg/dL) and 37 patients were diabetic with fasting blood glucose levels above 125 mg/dL.

“This is a very critical study,” Richard Dolinar, MD, a private practice physician in Phoenix and a member of the legislative and regulatory committee of the AACE, told MedPage Today.

“What it showed was that even though the glucose levels were not at the level of diabetes there was an impact on the body in regards to hypertension and lipids, etc. It shows there, indeed, is an abnormality there. The fasting glucose below 100 mg/dL is normal. Fasting glucose above 126 mg/dL is diabetes. But that in between area is significant and that is what this study shows.”

Al-Shuwaykh said, “Our study emphasizes the role of the primary care physician and the endocrinologist in how to deal with this problem. We have to intervene early and create an educational program to prevent impaired fasting glucose and if it is diagnosed we should act on it promptly.

“Usually what we tell the patient is to exercise, diet, lose weight and most of those patients will try but it is really difficult for them and a lot of them will ignore the problem and they come later with coronary artery disease. So our recommendation is to treat those patients and to follow with exercise for a goal of taking them out of treatment when they really commit to a diet and exercise program.”

“Studies like this impact pharmacologic intervention with impaired fasting glucose,” Dolinar said. “Historically we have told our patients to diet and exercise and that is a good idea, but it just doesn’t work. Fortunately we have pharmaceutical interventions so that when we have patients with Type 2 diabetes we can intervene with a variety of medications.

“I think that in the case of prediabetes we should consider intervening pharmacologically because there are abnormalities there that we could treat. It would be off label but I think it would be important to look at that and get more studies and study this further,” he said.

Al-Shuwaykh said there were limitations to his study, particularly the retrospective design and the lack of a control group.

Primary source: American Association of Clinical Endocrinologists
Source reference: Al-Shuwaykh H, et al “Impaired fasting glucose as a risk Ffactor for coronary artery disease compared to diabetes mellitus and normal blood sugar in association with other CAD risks” AACE 2013; Abstract 257.