Study: Cardiovascular Risk Heightened With Prediabetes


Individuals with prediabetes may be at increased risk of suffering an adverse cardiovascular event.


Individuals with prediabetes may be significantly more likely to experience a heart attack, stroke, or other major cardiovascular (CV) event than those with normal blood sugar levels, according to new research.

The findings, which were presented at the American College of Cardiology’s 70th Annual Scientific Session, underscore the seriousness of prediabetes and the need for more aggressive prevention and treatment. Although diabetes is known to be linked with an increased risk of CV events, the effects of prediabetes have been less clear, investigators noted. It is estimated that 34 million Americans have diabetes and another 88 million have prediabetes, according to the CDC. 

The single-center, retrospective study analyzed data from 25,829 patients treated within the Beaumont Health System in Michigan between 2006 and 2020. Patients were divided into the prediabetes or control group based on at least 2 glycated hemoglobin (A1C) levels 5 years apart. Overall, 12,691 patients and 13,138 were included in the prediabetes and control groups, respectively. Patients were followed for 14 years. 

Based on the data, serious CV events occurred in 18% of patients with prediabetes compared with 11% of those without prediabetes over a median of 5 years follow-up. The association between prediabetes and CV events remained significant even after taking into account other factors, such as age, gender, body mass index, blood pressure, cholesterol, sleep apnea, smoking, and peripheral artery disease, according to the investigators.

“As clinicians, we need to spend more time educating our patients about the risk of elevated blood sugar levels and what it means for their heart health and consider starting medication much earlier or more aggressively, and advising on risk factor modification, including advice on exercise and adopting a healthy diet,” said lead study author Adrian Michel, MD, internal medicine resident at the Beaumont Hospital-Royal Oak, Michigan.

Overall, having prediabetes nearly doubled the change of a major adverse CV events. However, even when patients with prediabetes brought their blood sugar back to normal, the risk still remained high. CV events were reported in just over 10.5% of these patients compared with 6% of those with no diabetes or prediabetes, according to the study.

As prediabetes usually has no symptoms, it is especially important to counsel on the importance of adults knowing their blood sugar numbers.

Pharmacists can play an important role in helping patients with prediabetes reduce their risk of CV events through education, medications for risk reduction, and lifestyle modifications. The Community Preventive Services Task Force recommends tailored pharmacy-based interventions to enhance adherence in patients with CV risk. Furthermore, pharmacists can communicate interventions with the patient’s primary care provider as an interdisciplinary approach to cardiovascular disease prevention. 


  1. Prediabetes May Not Be as Benign as Once Thought. News Release. American College of Cardiology; May 5, 2021. Accessed May 7, 2021. 
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