Association of prediabetes, defined by fasting glucose, HbA1c only, or combined criteria, with the risk of cardiovascular disease in Koreans.
BACKGROUND
The aim of the present study was to compare the association between cardiovascular diseases (CVD) and prediabetes defined by either fasting plasma glucose (FPG), HbA1c, or their combination in a Korean population.


METHODS
In all, 76 434 South Koreans who voluntarily underwent a general health examination in the Health Screening & Promotion Center (Asan Medical Center) were analyzed after excluding patients with a previous history of CVD. Cardiovascular events and death due to CVD during a median follow-up period of 3.1 years (interquartile range 1.9-4.3 years) were identified from the Nationwide Health Insurance Claims Database and death certificates using ICD-10 codes.


RESULTS
Age- and sex-adjusted hazard ratios (HRs) for overall CVD events were significantly greater for subjects with prediabetes defined by FPG only (HR 1.19; 95% confidence interval [CI] 1.08-1.31), HbA1c only (HR 1.28; 95% CI 1.16-1.42), and combined criteria (HR 1.20; 95% CI 1.09-1.32) compared with the normoglycemic group. After adjusting for multiple conventional risk factors (e.g. hypertension, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, smoking status, family history of CVD, and BMI), the HRs for overall CVD were significantly increased only for participants with prediabetes defined by HbA1c. Age- and sex-adjusted HRs for major ischemic heart disease events were significantly increased for subjects with prediabetes defined either by HbA1c or combined criteria. Similarly, age- and sex-adjusted HRs for percutaneous coronary intervention were significantly higher for subjects with prediabetes defined by HbA1c only. For diabetes, the multivariate-adjusted HRs for all outcomes were significantly increased by all three criteria.


CONCLUSIONS
Adding an HbA1c criterion when defining prediabetes in Koreans can help identify individuals with an increased risk of CVD.
Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Hong-Kyu
HK
Kim
Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Jung Bok
JB
Lee
Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea.
Seon Ha
SH
Kim
Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea.
Min-Woo
MW
Jo
Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Eun Hee
EH
Kim
Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Jenie Yoonoo
JY
Hwang
Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Sung Jin
SJ
Bae
Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea.
Chang Hee
CH
Jung
Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea.
Woo Je
WJ
Lee
Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea.
Joong-Yeol
JY
Park
Division of Cardiology, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea.
Gyung-Min
GM
Park
Division of Cardiology, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea.
Young-Hak
YH
Kim
Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Jaewon
J
Choe
D044466:Asian People; D001786:Blood Glucose / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000097:blood* / Q000175:diagnosis / Q000208:ethnology; D005215:Fasting / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011236:Prediabetic State / Q000097:blood* / Q000175:diagnosis / Q000208:ethnology; D056910:Republic of Korea; D012307:Risk Factors; D012680:Sensitivity and Specificity
D001786:Blood Glucose; D006442:Glycated Hemoglobin
HbA1c; Koreans; cardiovascular disease; fasting glucose; prediabetes; 心血管疾病; 空腹血糖; 糖尿病前期。; 韩国人