Background: To determine the impact of silent coronary artery disease (CAD), in different levels of glucose regulation at baseline, i.e., those with normal fasting glucose/normal glucose tolerance (NFG/NGT), pre-diabetic and newly diagnosed diabetes mellitus (NDM), on cardiovascular disease (CVD) and total mortality in Iranian populations.
Methods: The study population included 1809 individuals, aged ≥50years, free of CVD at baseline with a median follow-up of 12.1years. To explore the risk of CVD and mortality associated with the presence of silent CAD (as defined by Minnesota coding criteria for baseline electrocardiogram (ECG) in the absence of a history of CVD) in each of the glucose regulation categories, multivariate adjusted hazard ratios (HRs) were calculated for the presence of silent CAD, compared to the corresponding non-silent CAD counterpart, as reference.
Results: During follow-up 382 CVD (321 coronary heart disease) and 208 deaths (91 CVD mortality) occurred. Among the female population, the presence of silent CAD, independent of traditional risk factors, significantly increased the risk of CVD for population with NFG/NGT [2.40 (1.33-4.35)] and pre-diabetes [HR: 2.04 (1.14-3.63)]; however, in the male population the risk was significant for CVD [3.04 (1.53-6.05)] and mortality events [2.60 (1.22-5.56)] in the NDM population and marginally significant for mortality events in NFG/NGT.
Conclusion: Different strategies should be considered for silent CAD in males and females with different levels of glucose regulation. It might be justified that screening ECG for prevention of CVD events should be considered mainly among non-diabetic women and men with NDM.
Keywords: Cardiovascular disease; Impaired fasting glucose; Impaired glucose tolerance; Mortality; New onset diabetes mellitus; Normal fasting glucose/normal glucose tolerance; Silent coronary artery disease.
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