Abstract 4363217: Prediabetes, Obesity and Risk of Cardiovascular Disease among 1.3 million Patients from an Integrated Health Care System

Background: Prediabetes is a precursor to type 2 diabetes and a significant risk factor for atherosclerotic cardiovascular disease (ASCVD). There is concern for increasing the impact of prediabetes on risk of ASCVD, whereas large-scale contemporary data is lacking. Methods: We conducted a retrospective cohort study of adults (ages 18-90) between 2015-2018 without type 1 or 2 diabetes and without established ASCVD. All individuals were members of Kaiser Permanente Northern California, a large integrated health care delivery system. Using electronic health records, we identified individuals with prediabetes and identified a similarly sized comparison cohort of adults without prediabetes. Multivariable Cox proportional hazards models were specified to estimate the hazards of 5-year ASCVD risk by prediabetes and obesity (BMI ≥30 mg/dL) status, adjusted for baseline characteristics for the entire cohort and stratified by obesity. Incident ASCVD events were defined as a composite of nonfatal myocardial infarction, ischemic stroke, or coronary heart disease death through December 31, 2023. Results: A total 1,358,882 individuals met the selection criteria. Of these, 688,575 (50.7 %) had prediabetes and of those with prediabetes, 260,795 had obesity. The comparison group was those without prediabetes at baseline. The mean age was 52.5 years, 55.8% were women, and the mean follow up time was 4.1 years. Both prediabetes with obesity (HR 1.29, 95% CI 1.25-1.34) and prediabetes without obesity (HR 1.19, 95% CI 1.16,1.23) were significantly associated with 5-year ASCVD risk compared to those without prediabetes (Table). ASCVD free Kaplan-Meier curve showed similar significant higher risk (p < 0.001) (Figure). Conclusion: Prediabetes and prediabetes plus obesity had worse outcomes overtime. Early lifestyle and pharmacologic interventions to address both obesity and prediabetes are warranted.