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High cardiovascular disease risk-associated with the incidence of Type 2 diabetes among prediabetics

  • Azam Dekamin
    Correspondence
    Corresponding author.
    Affiliations
    Department of Mechanical and Industrial Engineering, Toronto Metropolitan University, 350 Victoria Street, Toronto ON M5B 2K3, Canada
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  • M.I.M. Wahab
    Affiliations
    Department of Mechanical and Industrial Engineering, Toronto Metropolitan University, 350 Victoria Street, Toronto ON M5B 2K3, Canada
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  • Karim Keshavjee
    Affiliations
    Institute of Health Policy, Management and Evaluation, University of Toronto, Dalla Lana School of Public Health, Toronto ON M5T 3M6, Canada
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  • Aziz Guergachi
    Affiliations
    Ted Rogers, School of Information Technology Management, Toronto Metropolitan University, 350 Victoria Street, Toronto ON M5B 2K3, Canada

    Ted Rogers, School of Management, Toronto Metropolitan University, 350 Victoria Street, Toronto ON M5B 2K3, Canada

    Department of Mathematics and Statistics, York University, N520 Ross, 4700 Keele Street, Toronto ON M3J 1P3, Canada

    Fields Institute for Research in Mathematical Sciences, 222 College St., Toronto, Ontario, Canada
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Published:September 22, 2022DOI:https://doi.org/10.1016/j.ejim.2022.09.005

      Highlights

      • Prediabetes is a risk factor for the development of Type 2 diabetes mellitus (T2D).
      • There are some evidences that Cardiovascular diseases (CVD) have been considered one of the influential confounding factors in T2D.
      • The present study indicated prediabetes patients with higher CVDs risk associated with an elevated risk of developing T2D compared to the control population (Adjusted hazard ratio (HR): 1.24 [95% confidence interval (CI), 1.10-1.31]).
      • The total effect of CVDs risk on developing T2D was decomposed to a natural direct effect of high CVDs risk HR= 1.18 [95% CI, 1.01-1.48] and an indirect effect through statin therapy of HR= 1.06 [95% CI, 0.97-1.30].

      Abstract

      Background

      Prediabetes is a risk factor for developing Type 2 diabetes mellitus (T2D). We report on the first cohort study of the association between high cardiovascular diseases (CVD) risk with the incidence of T2D in prediabetics. First, estimate the direct effect of developing T2D on patients with prediabetes who have high CVDs risk; and 2) assess the potential increased risk of developing T2D mediated by statins.

      Methods

      We conducted a population-based cohort study using a subset of data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) from 2000 to 2015. Cox proportional hazards (PH) regressions were conducted to estimate our primary outcome, which is the time to T2D among patients with prediabetes.

      Results

      From the 4995 filtered prediabetic participants identified between 2000 and 2015, 2800 participants were diagnosed with high CVDs risk scores as measured by the Framingham risk score. 2195 participants were non-high CVDs risk controls. The covariate-adjusted hazard ratio (HR) of 1.24 [95% confidence interval (CI), 1.10-1.31] for T2D by CVDs risk among prediabetics was observed. The total effect of CVDs risk on developing T2D was decomposed to a natural direct effect of high CVDs risk HR= 1.18 [95% CI, 1.01-1.48] and an indirect effect through statin therapy of HR= 1.06 [95% CI, 0.97-1.30].

      Conclusion

      Patients with prediabetes and high CVDs risk had a 24% higher chance of developing T2D. The high CVDs risk effect was mediated by statin therapy. Regular monitoring and counselling of prediabetics using statins is likely warranted to prevent the incidence of T2D.

      Keywords

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