A prediabetes diagnosis is a sign that blood sugar levels are not in a healthy range, and type 2 diabetes could be around the bend. Now, new Kaiser Permanente research shows there is another reason to be concerned about prediabetes: It also increases risk for heart disease.
“This study adds a whole new perspective,” said senior author Julie Schmittdiel, PhD, associate director for Health Care Delivery and Policy at the Kaiser Permanente Division of Research. “It suggests that when you treat prediabetes earlier you have the potential to prevent both diabetes and heart disease, especially in younger adults.”
The study, published in the American Journal of Preventive Cardiology, included more than 1.3 million members of Kaiser Permanente in Northern California, ages 18 to 90. Half the group had a normal blood sugar level. The other half had prediabetes. None had previously been diagnosed with diabetes or heart disease.
The study looked at each group’s risk for atherosclerotic cardiovascular disease. This type of heart disease is caused when plaque — fat, cholesterol, and other substances — slowly builds up inside the arteries, making it hard for blood to flow. This slower blood flow increases the risk for a heart attack, stroke, or needing surgery to treat blocked arteries.
Over the 5 years the adults were studied, there were 28,615 heart attacks, strokes, or surgeries needed for heart disease. For the adults with prediabetes, the risk of one of these events occurring was 21% higher than it was in the adults with normal blood sugar levels.
“Prediabetes can feel deceptively quiet — no symptoms, no alarms,” said Kevin C. Yee, MD, an internal medicine specialist at Kaiser Permanente in Northern California. “But this study shows that at this early stage the biology that increases risk for heart disease is already in motion. It reminds me of an iceberg: What looks small on the surface, peeking out from the waves, can carry substantial risk underneath.”
Higher risk groups
Nearly 1 in 3 people in the study had obesity, a known risk factor for prediabetes and type 2 diabetes. The research showed that the adults with both obesity and prediabetes had a 32% increased risk of having a stroke, heart attack, or surgery due to heart disease. In contrast, the adults who had only prediabetes had a 22% increased risk, while those who had only obesity had a 10% increased risk.
The risk of developing heart disease and having a stroke, heart attack, or needing surgery, was highest in adults with prediabetes ages 18 to 34. They had a 54% increased risk for cardiovascular disease, while adults ages 35 to 44 had a 26% higher risk than adults of the same age with normal blood sugar.
“This makes sense,” said Mehreen Khan, MD, MPH, an endocrinologist at Kaiser Permanente in Northern California. “Chronic inflammation and insulin resistance are hallmarks of prediabetes and obesity, and they set the stage for other health problems.”
One in three American adults have prediabetes, and it affects people of all ages. Kaiser Permanente in Northern California expects to implement a prevention program later this year for people with this condition who are at highest risk for diabetes.
“It’s exciting to know that our research is directly leading to changes in clinical care,” said study author Jamal S. Rana, MD, PhD, a cardiologist with Kaiser Permanente in Northern California, and DOR adjunct investigator. “The ethos of Kaiser Permanente is to act upstream — where prevention, integration, and coordinated care can change the entire course of a patient’s heart health.”
