Persistence or regression of prediabetes and coronary artery calcification among adults without diabetes

Objective: the effect of changes in glycemic status on subclinical atherosclerosis is uncertain. We assessed the association of persistence, regression or progression of prediabetes with coronary artery calcium score (CACS) as a measure of subclinical atherosclerosis. Design: a cross-sectional study, comprising 126,765 adults, and longitudinal sub-study, comprising 40,622 adults (with baseline and at least one follow-up computed tomography scan to assess changes in CACS), were undertaken. Methods: changes in glycemic status over 1.5 years (interquartile range, 1.0–2.0) before the first CACS assessment were categorized according to six groups: persistent normoglycemia (reference), normoglycemia to prediabetes, normoglycemia to diabetes, prediabetes to normoglycemia, persistent prediabetes, and prediabetes to diabetes. Logistic regression was used to calculate the odds ratios (ORs) and 95% CIs for prevalent coronary artery calcification (CAC). Mixed models with random intercepts and random slopes were used to estimate 5-year CAC progression rates.Results: mean (SD) age was 41.3 (7.0) years (74.7% male) (n=126,765). Multivariable61 adjusted OR for prevalent CAC was 1.12 (95% CI 1.07–1.18) for persistent prediabetes, 1.05 (0.98−1.13) for regression to normoglycemia, and 1.43 (95% CI 1.25–1.64) for progression from prediabetes to diabetes, compared with persistent normoglycemia. CAC progression increased significantly in all prediabetes groups. Multivariable-adjusted ratio of 5-year CAC progression rates was 1.19 (95% CI 1.16–1.22) (persistent prediabetes), 1.11 (1.07−1.14) (regression to normoglycemia) and 1.63 (95% CI 1.26−2.10) (progression from prediabetes to diabetes). Conclusions: unfavorable changes in glycemic status, including persistence of prediabetes or progression to diabetes from prediabetes, were associated with increased risk of CAC.