Cardiovascular and Kidney Disease Risk Across the Glycaemic Spectrum

Pavankumar Kamat


June 03, 2021


Why this matters

  • Findings emphasise the need to design specific cardiovascular and kidney risk reduction strategies across the glycaemic spectrum, including below thresholds used to define diabetes.

Study design

  • This study included 336,709 participants from the UK Biobank without prevalent type 1 diabetes, ASCVD, CKD and HF.

  • Primary outcomes: ASCVD (composite of coronary artery disease, ischaemic stroke and peripheral artery disease), CKD and HF.

  • Funding: None.

Key results

  • Of 336,709 participants, 277,081 (82.3%) had normoglycaemia, 46,911 (13.9%) had pre-diabetes and 12,717 (3.8%) had T2D.

  • Over a median follow-up of 11.1 years, 6476 (13.8%) participants with pre-diabetes developed ≥1 incident outcome (ASCVD, CKD and HF).

  • Of these, 1930 (29.8%) developed T2D during follow-up and 802 (12.4%) developed T2D prior to an incident diagnosis.

  • Pre-diabetes was associated with an increased risk of (adjusted HR [aHR]; 95% CI):

    • ASCVD (1.11; 1.08-1.15; P<.001);

    • CKD (1.08; 1.02-1.14; P=.009); and

    • HF (1.07; 1.01-1.14; P=.03).

  • Similarly, T2D was associated with an increased risk of (aHR; 95% CI):

    • ASCVD (1.44; 1.37-1.51);

    • CKD (1.57; 1.46-1.69); and

    • HF (1.25; 1.14-1.37; P<.001 for all).

  • Compared with HbA1c <5.0%, risks of ASCVD significantly increased above HbA1c 5.4%, CKD above HbA1c 6.2% and HF above HbA1c 7.0%.


  • Underestimation of population attributable risks associated with dysglycaemia.


Honigberg MC, Zekavat SM, Pirruccello JP, Natarajan P, Vaduganathan M. Cardiovascular and Kidney Outcomes across the Glycemic Spectrum: Insights from the UK Biobank. J Am Coll Cardiol. 2021 May 11 [Epub ahead of print]. doi: 10.1016/j.jacc.2021.05.004. PMID: 34015477.  View abstract 

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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