# Glucose metabolism disorders and changes in cardiovascular risk among adult Peruvian population

## TL;DR

This study shows that people with prediabetes and type 2 diabetes in Peru have higher cardiovascular risk and blood pressure compared to those with normal glucose levels.

## Contribution

The study provides new evidence on the long-term cardiovascular risk associated with glucose metabolism disorders in a Peruvian population.

## Key findings

- At baseline, individuals with prediabetes and diabetes had higher cardiovascular risk and mean arterial pressure.
- After six years, mean arterial pressure decreased more in people with normal glucose levels than in those with prediabetes or diabetes.
- Cardiovascular risk remained unchanged over time, but mean arterial pressure was still higher in those with glucose metabolism disorders.

## Abstract

Rates of cardiovascular diseases are increasing annually, and glucose metabolism disorders play an important role in cardiovascular risk. This study aimed to assess changes in cardiovascular risk over time according to the levels of blood glucose, especially prediabetes and type 2 diabetes.

Prospective cohort study conducted in the northern Peru. Two were the outcomes of interest, evaluated at the cohort’s baseline and six years after: cardiovascular risk (in percentage), defined using the laboratory-free risk score (HEARTS from the World Health Organization), and the mean arterial pressure (in mmHg); whereas the exposure was glucose metabolism disorder, especially prediabetes and type 2 diabetes, compared to normoglycaemia. Associations were evaluated using mixed linear regression models, and coefficients (β) and 95% confidence intervals (95% CI) were reported.

A total of 1607 subjects were recruited, with a mean age of 48.0 (standard deviation [SD]: 10.5) years, and 50.3% women. Baseline prevalence of prediabetes and type 2 diabetes was 16.9% (95%CI: 15.1%-18.9%) and 11.0% (95%CI: 9.5%-12.6%), respectively; whereas the average of the cardiovascular risk and mean arterial pressure was 3.0% (SD: 2.5%) and 93.1 (SD: 11.9) mmHg, respectively. At baseline, those with prediabetes and type 2 diabetes had a higher cardiovascular risk (0.31% and 0.33%, respectively) and a higher mean arterial pressure (3.3 and 4.2 mmHg, respectively) than those with normal glycaemia. No significant change was found in cardiovascular risk between baseline and follow-up; however, there was a reduction in mean arterial pressure levels, greater among those with normoglycaemia than in cases of prediabetes and type 2 diabetes.

Glucose metabolism disorders were associated with an increased cardiovascular risk and mean arterial pressure at baseline, but only with higher levels of mean arterial pressure at follow-up. These findings suggest the need for cardiovascular risk assessment in patients with prediabetes and type 2 diabetes.

Subjects with alteration of the glucose metabolism, especially those with prediabetes and diabetes are at high cardiovascular risk. This is evaluated in this manuscript using two different indicators, a cardiovascular risk score (estimated using the WHO HEARTS tool) and the mean arterial pressure (estimated using the measurements of blood pressure). At the baseline of the study, individuals with prediabetes and diabetes had high cardiovascular risk and mean arterial pressure compared to those with normal glycaemia. At follow-up, on average, 6 years later, no change in cardiovascular risk and a reduction of mean arterial pressure was reported. Mean arterial pressure was higher among those with prediabetes and diabetes.