Abstract 4371142: Diabetes Status and Cardiovascular Disease in U.S. Adults: Insights from NHANES 2021–2022

Background: The cardiovascular impact of diabetes and prediabetes, especially in the context of behavioral risk factors and comorbidities, remains an urgent public health issue. We evaluated cardiometabolic burden and predictors of cardiovascular disease (CVD) among adults with diabetes or prediabetes in the U.S. Methods: We analyzed National Health and Nutrition Examination Survey (NHANES) 2021–2022 data on adults aged ≥18 years, using non survey-weighted methods. Diabetes status was defined by self-reported diabetes or prediabetes. Cardiometabolic burden was computed as a composite of self-reported hypertension, obesity, hyperlipidemia, and smoking. CVD was defined as any self-reported congestive heart failure, coronary heart disease, myocardial infarction, stroke, or angina. Logistic regression identified independent predictors of CVD adjusting for sociodemographics, comorbidities, and behaviors. Results: A total of 9,693 were included in final analysis. Among these, 14.7% had diabetes and 9.5% had prediabetes. Adults with diabetes had higher cardiometabolic burden (mean 2.74; 95% CI: 2.65–2.83) than those with prediabetes (mean 2.37; 95% CI: 2.25–2.50; Figure 1). Current smoking and physical inactivity were common in both groups (Figure 2). Independent predictors of increased CVD included older age (OR: 1.05 per year), hypertension (OR: 2.38), and non-Hispanic Black race (OR: 2.94). Female sex (OR: 0.64) and higher income (OR: 0.87 per unit of PIR) were associated with lower CVD risk. In adjusted models (Figure 3), prediabetes did not have a positive association with CVD (OR: 0.58; 95% CI: 0.36–0.95). Conclusions: Diabetes and prediabetes are highly prevalent and linked to elevated cardiometabolic burden. However, prediabetes alone may not independently increase CVD risk. Findings highlight the need for aggressive risk factor management and equitable care strategies in cardiometabolic disease prevention.