부산대학교 도서관

Background: The population of adults with prediabetes is growing worldwide. The value of coronary artery calcium (CAC) testing to assess ASCVD risk in this group is poorly defined.Methods: We pooled participants free of clinical ASCVD from 4 prospective cohort studies including the Multi-Ethnic Study of Atherosclerosis (MESA), Heinz Nixdorf Recall (HNR) Study, Framingham Heart Study (FHS), and Jackson Heart Study (JHS). Participants were classified as having euglycemia, prediabetes, and diabetes. Cox proportional hazards models were used to study the association between glycemia status and CAC burden and incident ASCVD, adjusting for potential confounders.Results: The study population included 14,780 participants with mean (SD) age 58 (11) years, 54% women, 57% White, 27% Black, and 16% Other. A total of 11,429 had euglycemia, 810 had prediabetes, and 2,207 had diabetes. The distribution of CAC is shown in Panel A. Among those with prediabetes, 31% had CAC>100. Individuals with prediabetes and CAC>100 had higher event rates than participants with diabetes and those with diabetes and a guideline indication for GLP1RA/SGLT2i therapy (Panel B). In adjusted analyses, compared to individuals with euglycemia, the HR (95% CI) for ASCVD was 0.70 (0.41, 1.19) for prediabetes and CAC=0, 1.10 (0.76, 1.06) for prediabetes and CAC 1-99, 1.80 (1.37, 2.38) for prediabetes and CAC≥100, 1.82 (1.56, 2.13) among those with diabetes and 1.69 (1,42, 2.02) among those with diabetes and an indication for GLP1RA/SGLT2i.Conclusion: CAC>100 is frequent among individuals with prediabetes and identifies a subgroup at very high risk of ASCVD events. Adjusted 10-year ASCVD risk among individuals with prediabetes and CAC ≥100 is similar compared to people with diabetes and those with a guideline indication for GLP1RA/SGLT2i. Future clinical trials should assess whether individuals with prediabetes and CAC ≥100 benefit from cardiovascular risk-reduction with GLP1RA and/or SGLT2i.