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Pre Diabetes as Risk Factor for Coronary Artery Disease & 221
Peripheral Vascular Disease

Response to interventions References:
A 12-year follow-up of men with IGT who participat- 1. DeFronzo RA, Abdul-Ghani M. Assessment and treatment of cardiovascular
ed in the Malmö Feasibility Study revealed that all- risk in prediabetes: impaired glucose tolerance and impaired fasting glu-
cause mortality among men in the lifestyle interven- cose. Am J Cardiol2011;108(Suppl):3B-24B.
tion group was lower (and similar to that in men with 2. Rydén L, Grant PJ, Anker SD, et al. Authors/Task Force Members ESC
normal glucose tolerance) than that among men who Committee for Practice Guidelines (CPG) Document Reviewers. ESC
Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed
had received ‘routine care’ (6.5 vs. 6.4 per 1000 per- in collaboration with the EASD: the Task Force on diabetes, pre-diabetes,
son-years at risk; P = 0.009). In the Chinese Da Qing and cardiovascular diseases of the European Society of Cardiology (ESC)
study, participants with IGT in the 6-year lifestyle and developed in collaboration with the European Association for the Study
intervention group had, 20 years later, a persistent of Diabetes (EASD). Eur Heart J2013;34:3035-87.
reduction in the incidence of T2DM and a non-sig- 3. Prevalence and risk factors of peripheral vascular disease in a selected
nificant 17% reduction in CVD death while the adjust- South Indian population: the Chennai Urban Population Study.Diabetes
Care. 2000 Sep;23(9):1295-300
ed incidence of severe retinopathy was 47% lower in
the intervention group. In the 10-year follow-up of the 4. Tapp RJ, Balkau B, Shaw JE, Valensi P, Cailleau M, Eschwege E. Asso-
Finnish Diabetes Prevent on Study (DPS), total mor- ciation of glucose metabolism, smoking and cardiovascular risk factors
with incident peripheral arterial disease: the DESIR study. Atherosclero-
tality and CVD incidence were no different between sis. 2007;190(1):84–89.
the intervention and control groups, but the DPS 5. Vonbank A, Saely CH, Rein P, Drexel H. Insulin resistance is significantly
participants, who had IGT at baseline, had lower all- associated with the metabolic syndrome, but not with sonographically
cause mortality and CVD incidence compared with a proven peripheral arterial disease. CardiovascDiabetol. 2013;12:106.
Finnish population-based cohort of people with IGT.
.
Pre diabetes and Peripheral vascular disease:
Impaired fasting glucose and diabetes are common
in patients with PAD. PAD patients with non-medi-
cated diabetes showed higher rates of mortality and
peripheral artery intervention compared to patients
with normal fasting glucose. The exact reasons for
this remain unclear but, may reflect poor glycaemic
control compared to patients receiving oral hypogly-
caemics. Previous data suggest that poor diabetes
control, evidenced by high HbA1c concentrations, is
positively associated with major adverse events in
patients with established cardiovascular disease. It
is relevant to note that PAD patients with impaired
fasting glucose had similar mortality and requirement
for peripheral artery intervention as patients with
normal fasting glucose in this study.
The prevalence of PVD in this urban South Indian
population is considerably lower than that reported in
European and U.S. studies and is in marked contrast
to the high prevalence rate of CAD reported in this
population. Although incidence of IGT is high in our
population it is not associated with increased prev-
alence of atherosclerotic peripheral arterial disease.

Prevalence of Pre diabetes in PAD
High prevalence of glucose intolerance in Japanese
patients with high cardiovascular risk found also high
PAD. The US PARTNERS program, designed to study
the prevalence of PAD and other cardiovascular dis-
eases, found a prevalence of PAD of 29% in individ-
uals aged > 70 or > 50 with comorbidities (diabetes,
IGT and smoking).

Cardio Diabetes Medicine