Prediabetes and coronary heart disease

Abstract

Background: The prevalence of diabetes and abnormal glucose metabolism is increasing dramatically all over the world. People with disturbed glucose metabolism are at an increased risk for cardiovascular disease. This risk starts before diabetes is established. A significant proportion of dysglycaemic individuals develop vascular damage during the prediabetes stage, although their glucometabolic perturbations often remain undetected until the first cardiovascular event. Development of macrovascular complications substantially influences patient’s prognosis and decrease survival. Recent studies showed that the incidence of dysglycemia in subjects with coronary artery disease is high. The importance of detecting glucose perturbation is strongly underscored by the fact that a patient with normal glucose tolerance has a considerably better outcome during follow-up than those with abnormal glucose metabolism. An oral 75 gr glucose tolerance test is strongly recommended in all non-diabetic patients with coronary artery disease. Early detection of abnormal glucose tolerance and target-driven multifactorial management of risk factors may effectively improve the prognosis for these persons, delay the development of the future diabetes and macrovascular complications. Conclusions: Since the prevalence of type 2 diabetes mellitus and impaired glucose tolerance are rapidly increasing in the population, the association of cardiovascular disease with these glucose perturbations will become more common resulting in a poor prognosis and a negative impact on health care expenditures. Screening for abnormal glucose metabolism in patients with cardiovascular disease and proper multifactorial management of these individuals has a great clinical importance.