Prediabetes diagnosis is associated with the progression of coronary artery calcification: the Kangbuk Samsung Health Study

Aims: The implications of prediabetes diagnosed by isolated glucose versus glycated hemoglobin (HbA1c) on subclinical atherosclerosis are uncertain. We investigated associations between prediabetes defined by different diagnostic criteria and coronary artery calcification (CAC) and its progression over time.
Materials and methods: The cross-sectional study included 146,436 Korean adults without diabetes who underwent CAC estimation computed tomography (CT) during health examinations between 2011 and 2019. We used multinomial logistic regression models. The longitudinal study comprised 41,100 participants with at least one follow-up cardiac CT and annual CAC progression rates and ratios were estimated. Prediabetes was categorized into 3 groups: isolated glucose prediabetes (fasting blood glucose (FBG) 100–125 mg/dl, HbA1c < 5.7%); isolated HbA1c prediabetes (FBG < 100 mg/dl, HbA1c 5.7–6.4%), and prediabetes meeting both FBG and HbA1c criteria (FBG 100–125 mg/dl, HbA1c 5.7%–6.4%).
Results: After adjusting for covariates, the prevalence ratios (95% CI) for CAC score> 100 comparing isolated glucose prediabetes, isolated HbA1c prediabetes, and prediabetes fulfilling both criteria to those of normoglycemia were 1.12 (0.99–1.26), 1.24 (1.11–1.39), and 1.31 (1.18–1.45), respectively. The multivariable-adjusted ratio (CIs) of annual CAC progression rates comparing the corresponding groups to the normoglycemia group were 1.031 (1.023–1.039), 1.025 (1.019–1.032), and 1.054 (1.047–1.062), respectively.
Conclusions: CAC risk and CAC progression were consistently highest in individuals meeting both glucose and HbA1c criteria, while all three prediabetes types showed significantly increased risk of CAC progression. Atherosclerosis risk reduction management is necessary for prediabetes, especially in patients meeting both criteria.