Great debate: pre-diabetes is not an evidence-based treatment target for cardiovascular risk reduction

With the increasing burden of diabetes as a cause of macro- and microvascular disease linked to the epidemics of obesity, attention is being paid to dysglycaemic states that predict and precede the development of type 2 diabetes. Such conditions, termed pre-diabetes, are characterized by fasting plasma glucose, or plasma glucose levels on an oral glucose tolerance test, or values of glycated haemoglobin intermediate between 'normal' values and those characterizing diabetes. These last are by definition associated, in epidemiological terms, with a higher incidence of microvascular disease-mostly retinopathy. Pre-diabetes overlaps with the components of the 'metabolic syndrome'-among which are excess visceral adiposity; hypertension; hypertriglyceridaemia; high levels of small, dense low-density lipoproteins; and metabolic-associated fatty liver disease. There is little doubt that pre-diabetes has important prognostic implications, especially for the occurrence of myocardial infarction, ischaemic stroke, and peripheral arterial disease. It is disputed, however, whether pre-diabetes is itself an actionable disease entity, in addition to the risk factors characterizing it. Because of this uncertainty, the latest European Society of Cardiology guidelines chose not to include pre-diabetes as a treatment target for atherosclerotic cardiovascular disease, at variance from the three previous editions of such guidelines. This is spurring a debate, the Pro and Contra arguments featured in the present debate article.

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Publication Details

Journal
European Heart Journal
Published
2024-10-10
DOI
https://doi.org/10.1093/eurheartj/ehae533
Citations
11
Primary Topic
Diabetes, Cardiovascular Risks, and Lipoproteins
Type
article
Field-Weighted Citation Impact
3.93
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article

Great debate: pre-diabetes is not an evidence-based treatment target for cardiovascular risk reduction

Marlo Verket, David Michael Wood, Nikolaus Marx, Hertzel C. Gerstein et al.
11 citations
European Heart Journal
Diabetes, Cardiovascular Risks, and Lipoproteins
3.93
article

Great debate: pre-diabetes is not an evidence-based treatment target for cardiovascular risk reduction

Marlo Verket, David Michael Wood, Nikolaus Marx, Hertzel C. Gerstein, Linda Mellbin, Lars Rydén, Massimo Federici, Rury R. Holman, Raffaele De Caterina, Francesco Cosentino, Subodh Verma, Dirk Müller‐Wieland, Eberhard Standl, Juliana Chan, Jaakko Tuomilehto, Kausik K Ray, Katharina Marx-Schütt
article en
11 citations

Abstract

With the increasing burden of diabetes as a cause of macro- and microvascular disease linked to the epidemics of obesity, attention is being paid to dysglycaemic states that predict and precede the development of type 2 diabetes. Such conditions, termed pre-diabetes, are characterized by fasting plasma glucose, or plasma glucose levels on an oral glucose tolerance test, or values of glycated haemoglobin intermediate between 'normal' values and those characterizing diabetes. These last are by definition associated, in epidemiological terms, with a higher incidence of microvascular disease-mostly retinopathy. Pre-diabetes overlaps with the components of the 'metabolic syndrome'-among which are excess visceral adiposity; hypertension; hypertriglyceridaemia; high levels of small, dense low-density lipoproteins; and metabolic-associated fatty liver disease. There is little doubt that pre-diabetes has important prognostic implications, especially for the occurrence of myocardial infarction, ischaemic stroke, and peripheral arterial disease. It is disputed, however, whether pre-diabetes is itself an actionable disease entity, in addition to the risk factors characterizing it. Because of this uncertainty, the latest European Society of Cardiology guidelines chose not to include pre-diabetes as a treatment target for atherosclerotic cardiovascular disease, at variance from the three previous editions of such guidelines. This is spurring a debate, the Pro and Contra arguments featured in the present debate article.

European Heart JournalVol. 45(48)
University of Pisa (IT), University of Rome Tor Vergata (IT), St. Michael's Hospital (CA), University of Helsinki (FI), King Abdulaziz University (SA), University of Toronto (CA), Ollscoil na Gaillimhe – University of Galway (IE), Instituto de Salud Carlos III (ES), Population Health Research Institute (CA), Karolinska Institutet (SE), Helmholtz Zentrum München (DE), Finnish Institute for Health and Welfare (FI), University of Oxford (GB), Escuela Nacional de Sanidad (ES), Instituto Nacional de Ciência e Tecnologia de Obesidade e Diabetes (BR), Universitätsklinikum Aachen (DE), Oxford Centre for Diabetes, Endocrinology and Metabolism (GB), Policlinico Tor Vergata (IT), St Michaels Hospital (GB), Hamilton Health Sciences (CA), RWTH Aachen University (DE), University of Hong Kong (HK), McMaster University (CA)
Good health and well-being
Openalex Percentile: Top 5%
Diabetes, Cardiovascular Risks, and Lipoproteins
3.93
DOISourceOpenAlex
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