Pre-diabetes is a risk factor for heart attack even in young people, study finds

Research by American scientists has found a possible association between being pre-diabetic (when your blood sugar level is between 100 and 125 milligrams per deciliter) and having heart attacks, even in young individuals aged between 18 and 44.

According to the study, having a diagnosis of pre-diabetes can indicate a 1.7 times greater risk of hospitalization for heart problems compared to those with normal blood sugar (below 100 mg/dL).

Despite this higher risk, the researchers say they have not found an association between prediabetes and the occurrence of cardiac arrest or heart attack.

The preliminary results of the research were released on May 14 at the Quality of Care and Scientific Research Outcomes seminar, organized by the American Heart Association, in Reston, Virginia (USA).

The survey analyzed data from 7.8 million Americans between the ages of 18 and 44 hospitalized in the country in 2018, according to data from the National Sample of Inmates, which gathers public hospitalization data in the United States.

Of the total number of patients analyzed, 31,000 (0.4%) had blood sugar levels that classified them as pre-diabetic. Among them, the incidence rate of heart attack was 21.5 per thousand individuals, while in people with normal blood level it was 3 per thousand.

In addition, the prevalence of other risk factors, such as hypertension, high cholesterol (68.1% against 47.3%) and obesity (48.9% against 25.7%) was higher in pre-diabetics. Scientists also noted that pre-diabetic adults hospitalized for heart attack were mostly black, Hispanic or Asian men, compared to other ethnicities.

Despite this increased incidence of heart attack, scientists have not found a higher occurrence of heart attacks or strokes in people with prediabetes compared to those without.

“It is possible that prediabetes may influence mid- or long-term outcomes after a myocardial infarction, given that it is not as acute a health condition as the diagnosis of type 2 diabetes,” said researcher and study author Akhil. Jain of Mercy Catholic Medical Center in Darby (Pennsylvania).

According to Jain, if left untreated, prediabetes can quickly progress to type 2 diabetes, which is a known cardiovascular risk factor. “Future studies should focus more on outcomes with prediabetes and individuals without this condition in hospitalized patients who have had a heart attack to assess this risk,” she explains.

According to him, the study aims to indicate which public health measures and campaigns should be taken to reverse the situation and prevent new diagnoses of diabetes in the future. “It is essential to create awareness among young adults about the importance of having routine screenings that can indicate a diagnosis of prediabetes, controlling diet and engaging in physical activity to prevent or delay the development of type 2 diabetes and the heart disease that may be associated with it. “, he said.

In the US, according to data from the National Institute of Health (NIH), 88 million adults have a diagnosis of pre-diabetes, which is equivalent to more than a third of the population. Brazil does not have updated data, but a 2015 estimate by the Brazilian Society of Diabetes estimates that about 20% of the adult population was pre-diabetic, or 40 million people.

The percentage of adults living with diabetes has grown in the last two years, reaching 9.14%, or about 15 million people.

For Paulo Lotufo, epidemiologist and professor at the USP School of Medicine, there is sometimes a misinterpretation of what pre-diabetes is, because, according to him, several mechanisms can act to break the so-called glycemic homeostasis (balance) in the body, not only sugar consumption.

“Basically, we know that the further away from the blood glucose threshold that is considered normal, of 60 mg/dL, the risk of having diabetes increases, but the level of sugar that can be classified as pre-diabetes is somewhat questionable. In any case, we know that there is an increase in the level of sugar above 100 mg/dL in people who are overweight, and even in young individuals, increasing the risk of heart disease”, he explains.

According to Lotufo, however, it is important that people who have the so-called metabolic syndrome — high cholesterol, overweight, high glycemic level — be aware and try to reverse the situation before getting type 2 diabetes, when drug treatments are necessary.

“It is very common to see in routine clinical care men who arrive with overweight, high glycemic level, cholesterol and who have gained weight very quickly. mg/dL”, he explains.