OBJECTIVE To describe the epidemiology and prognostic value of coronary artery calcium (CAC) in individuals with prediabetes. RESEARCH DESIGN AND METHODS We pooled participants free of clinical atherosclerotic cardiovascular disease (ASCVD) from four prospective cohorts: the Multi-Ethnic Study of Atherosclerosis, Heinz Nixdorf Recall Study, Framingham Heart Study, and Jackson Heart Study. Two definitions were used for prediabetes: inclusive (fasting plasma glucose [FPG] ≥100 to <126 mg/dL and hemoglobin A1c [HbA1c] ≥5.7% to <6.5%, if available, and no glucose-lowering medications) and restrictive (FPG ≥110 to <126 mg/dL and HbA1c ≥5.7% to <6.5%, if available, among participants not taking glucose-lowering medications). RESULTS The study included 13,376 participants (mean age 58 years; 54% women; 57% White; 27% Black). The proportions with CAC ≥100 were 17%, 22%, and 37% in those with euglycemia, prediabetes, and diabetes, respectively. Over a median (25th–75th percentile) follow-up time of 14.6 (interquartile range 7.8–16.4) years, individuals with prediabetes and CAC ≥100 had a higher unadjusted 10-year incidence of ASCVD (13.4%) than the overall group of those with diabetes (10.6%). In adjusted analyses, using the inclusive definition of prediabetes, compared with euglycemia, the hazard ratios (HRs) for ASCVD were 0.79 (95% CI 0.62, 1.01) for prediabetes and CAC 0, 0.70 (0.54, 0.89) for prediabetes and CAC 1–99, 1.54 (1.27, 1.88) for prediabetes and CAC ≥100, and 1.64 (1.39, 1.93) for diabetes. Using the restrictive definition, the HR for ASCVD was 1.63 (1.29, 2.06) for prediabetes and CAC ≥100. CONCLUSIONS CAC ≥100 is frequent among individuals with prediabetes and identifies a high ASCVD risk subgroup in which the adjusted ASCVD risk is similar to that in individuals with diabetes.

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无症状糖尿病前期个体冠状动脉钙的流行病学和预后意义：一项多队列研究

目的 描述糖尿病前期个体冠状动脉钙 (CAC) 的流行病学和预后价值。研究设计和方法 我们从四个前瞻性队列中汇集了没有临床动脉粥样硬化性心血管疾病 (ASCVD) 的参与者：动脉粥样硬化多种族研究、Heinz Nixdorf 回忆研究、弗雷明汉心脏研究和杰克逊心脏研究。糖尿病前期有两种定义：包容性（空腹血糖 [FPG] ≥100 至 <126 mg/dL，糖化血红蛋白 [HbA1c] ≥5.7% 至 <6.5%，如果有的话，并且没有降血糖药物）和限制性（在未服用降糖药物的参与者中，FPG ≥110 至 <126 mg/dL，HbA1c ≥5.7% 至 <6.5%（如果有））。结果 该研究包括 13,376 名参与者（平均年龄 58 岁；54% 为女性；57% 为白人；27% 为黑人）。血糖正常、糖尿病前期和糖尿病患者中 CAC ≥100 的比例分别为 17%、22% 和 37%。在中位（第 25-75 个百分位）随访时间 14.6 年（四分位距 7.8-16.4）年中，糖尿病前期且 CAC ≥ 100 的个体未经调整的 10 年 ASCVD 发病率 (13.4%) 高于整个糖尿病组。患有糖尿病的人（10.6%）。在调整分析中，使用糖尿病前期的包容性定义，与血糖正常相比，ASCVD 的风险比 (HR) 为 0.79 (95% CI 0.62, 1.01)（糖尿病前期），CAC 0、0.70 (0.54, 0.89)（糖尿病前期和 CAC 1）对于糖尿病前期和 CAC ≥ 100，为 –99、1.54 (1.27、1.88)；对于糖尿病，为 1.64 (1.39、1.93)。使用限制性定义，糖尿病前期且 CAC ≥100 时 ASCVD 的 HR 为 1.63 (1.29, 2.06)。结论 CAC ≥100 在糖尿病前期个体中很常见，并且确定了高 ASCVD 风险亚组，其中调整后的 ASCVD 风险与糖尿病个体相似。