title: Association between prediabetes and risk of cardiovascular disease and all cause mortality: systematic review and meta-analysis.
abstract: OBJECTIVE
  To evaluate associations between different definitions of prediabetes and the risk of cardiovascular disease and all cause mortality.
  
  
  METHODS
  Meta-analysis of prospective cohort studies.
  
  
  METHODS
  Electronic databases (PubMed, Embase, and Google Scholar).
  
  
  METHODS
  Prospective cohort studies from general populations were included for meta-analysis if they reported adjusted relative risks with 95% confidence intervals for associations between the risk of composite cardiovascular disease, coronary heart disease, stroke, all cause mortality, and prediabetes.
  
  
  METHODS
  Two authors independently reviewed and selected eligible studies, based on predetermined selection criteria. Prediabetes was defined as impaired fasting glucose according to the criteria of the American Diabetes Association (IFG-ADA; fasting glucose 5.6-6.9 mmol/L), the WHO expert group (IFG-WHO; fasting glucose 6.1-6.9 mmol/L), impaired glucose tolerance (2 hour plasma glucose concentration 7.8-11.0 mmol/L during an oral glucose tolerance test), or raised haemoglobin A1c(HbA1c) of 39-47 mmol/mol : (5.7-6.4%) according to ADA criteria or 42-47 mmol/mol (6.0-6.4%) according to the National Institute for Health and Care Excellence (NICE) guideline. The relative risks of all cause mortality and cardiovascular events were calculated and reported with 95% confidence intervals.
  
  
  RESULTS
  53 prospective cohort studies with 1 611 339 individuals were included for analysis. The median follow-up duration was 9.5 years. Compared with normoglycaemia, prediabetes (impaired glucose tolerance or impaired fasting glucose according to IFG-ADA or IFG-WHO criteria) was associated with an increased risk of composite cardiovascular disease (relative risk 1.13, 1.26, and 1.30 for IFG-ADA, IFG-WHO, and impaired glucose tolerance, respectively), coronary heart disease (1.10, 1.18, and 1.20, respectively), stroke (1.06, 1.17, and 1.20, respectively), and all cause mortality (1.13, 1.13 and 1.32, respectively). Increases in HBA1cto 39-47 mmol/mol or 42-47 mmol/mol were both associated with an increased risk of composite cardiovascular disease (1.21 and 1.25, respectively) and coronary heart disease (1.15 and 1.28, respectively), but not with an increased risk of stroke and all cause mortality.
  
  
  CONCLUSIONS
  Prediabetes, defined as impaired glucose tolerance, impaired fasting glucose, or raised HbA1c, was associated with an increased risk of cardiovascular disease. The health risk might be increased in people with a fasting glucose concentration as low as 5.6 mmol/L or HbA1cof 39 mmol/mol.
authors.affiliation: Department of Cardiology, First People's Hospital of Shunde (Affiliated Hospital at Shunde, Southern Medical University), Foshan, 528300, China.
authors.forename: Yuli
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Clinical Medicine Research Centre, First People's Hospital of Shunde (Affiliated Hospital at Shunde, Southern Medical University), Foshan, China.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Cai
authors.affiliation: Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Weiyi
authors.initials: W
authors.lastname: Mai
authors.affiliation: Department of Cardiology, First People's Hospital of Shunde (Affiliated Hospital at Shunde, Southern Medical University), Foshan, 528300, China.|Department of Cardiology, Graduate College, Guangdong medical university, Zhanjiang, China.
authors.forename: Meijun
authors.initials: M
authors.lastname: Li
authors.affiliation: Department of Cardiology, First People's Hospital of Shunde (Affiliated Hospital at Shunde, Southern Medical University), Foshan, 528300, China.
authors.forename: Yunzhao
authors.initials: Y
authors.lastname: Hu
mesh_terms: D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D006801:Humans; D011236:Prediabetic State / Q000401:mortality*; D011446:Prospective Studies; D012306:Risk