Cardiovascular risk assessment in prediabetes: A hypothesis

Summary 

There are screening programs for future risk of cardiovascular disease (CVD) complications in diabetes, but not in subclinical diabetes. There is little or no risk and no differences between genders when a man or woman at age below 50 years presents blood pressure below 140/90mmHg and total cholesterol/HDL less down 7.0. In the current screening programs, a hypothetical apparently non-diabetic and non-smoking person aged 49 years old; who present blood pressure 140/90mmHg, fasting blood sugar 5.8mmol/L and total cholesterol/HDL 6.5 has no risk of future CVD and does not require any intervention. However, by counting numbers, the person has two risk factors, hyperglycaemia and hyperlipidaemia. Furthermore, considering smoking as a factor and the propensity for hyperglycaemia-induced oxidative stress being a smoker-like effect of hyperglycaemia toxicity, the person actually has three risk factors, which qualifies the person for intervention. The issue is that a prediabetes sufferer is treated like a healthy person in the current screening programs. The problem here is that risk of CVD in prediabetes is inadequately assessed. We present a hypothesis that employs a combination of blood glucose level and an index of oxidative damage to improve CVD screening in prediabetes. We propose a longitudinal study to repeat the whole lipid modelling exercise in order to develop a separate model chart for the screening of future CVD in people with diagnosed or undiagnosed prediabetes. The proposal would also serve for people with undiagnosed diabetes.