Prediabetes: An Emerging Risk Factor for Coronary Artery Disease

Prediabetes affects almost 40% of the United States, a significant proportion of the population. While most readily recognize the risks imposed by diabetes mellitus, fewer clinicians and patients recognize the potential risks associated with being diagnosed with prediabetes. Diabetes causes both micro- and macrovascular complications. The prevention of these complications serves as a significant target of evidence-based guidelines. Data continue to emerge that many of these classic complications associated with diabetes mellitus actually initiate and potentially manifest during the prediabetic state. Even marginally elevated blood glucose levels increase systemic inflammation and with atherosclerosis being a type of arterial injury and its inflammatory response, it should come as no surprise that prediabetics have a greater atherosclerotic burden than their normal glycemic counterparts. Furthermore, many patients who initially present with a myocardial infarction are found to be prediabetic, and prediabetics experience more cardiovascular events after having a myocardial infarction. In diabetics, silent myocardial infarctions represent the intersection of the recognizing macro- and microvascular complications. Emerging data indicate that prediabetics also develop silent myocardial infarctions. The most efficacious means available to prevent the risks imposed by prediabetes and prevent the progression to overt diabetes mellitus remains exercise and dietary changes. With a substantial segment of the population being prediabetic, public health measures should continue to reinforce the critical nature of a heart healthy lifestyle featuring exercise and prudent dietary choices to prevent the cardiovascular morbidity and mortality associated with an abnormal blood glucose level.