| BackgroundAtherosclerotic cardiovascular disease（ASCVD）is one of the greatest threats to global public health,and diabetes is a major risk factor.Abnormal glucose metabolism is currently prevalent in pre-diabetic or non-diabetic people and is usually defined by glycosylated hemoglobin(Hb A1c)5.7-6.4%.Multiple studies have shown that prediabetes is associated with increased risk of subclinical atherosclerosis and clinical ASCVD.The objective of this study was to investigate 10-year risk stratification of ASCVD in non-diabetic populations and the value of Hb A1c in primary prevention of cardiovascular disease in non-diabetic populations.MethodsPatients with first-episode type I acute myocardial infarction with onset≤24 hours were included in the Department of Cardiology,Dalian Central Hospital from January2010 to October 2022.Basic data of the patients were collected.According to theChinese Guidelines for Primary Prevention of Cardiovascular Diseases（2020 Edition）,the patients were classified into low-risk,medium-risk and high-risk groups for 10 years for ASCVD.According to the prediabetes defined by Hb A1c in the American Diabetes Association’s Diabetes Standards for Diagnosis and Treatment（2021 Edition）,the patients were also divided into two groups:prediabetes group and normal group.First,the baseline data of the two grouping methods were collected respectively to compare whether there were differences in ASCVD risk factors between the pre-diabetic group and the normal group.Secondly,the proportion of pre-diabetic patients in each risk stratification was analyzed.Finally,pre-diabetic patients were taken as risk factors to identify high-risk patients and risk reclassification was conducted for low-risk patients.The statistical difference in the rate of cholesterol failure rates before and after risk reclassification in low-risk patients was compared.ResultsA total of 281 non-diabetic patients with first-onset AMI were included in this study.271 patients（96.4%）underwent 10-year ASCVD risk stratification,and 10patients（3.6%）could not perform ASCVD score because LDL-c and TG levels were lower than the minimum threshold of 10-year ASCVD scoring criteria.1.Baseline dataOf 271 patients at 10-year ASCVD risk stratification,74（27.3%）were low-risk,93（34.3%）intermediate-risk,and 104（38.4%）high-risk.61.6%（167 cases）of patients with first episode acute myocardial infarction were assessed as having low to medium-risk ASCVD risk at the time of onset.Compared with low-risk patients,the levels of TC,LDL-c and TG were higher in intermediate and high-risk patients,and the proportion of hypertension was higher（P<0.05）.There were no significant differences in age,sex,BMI,HDL-c,glomerular filtration rate,Hb Alc and fasting blood glucose among the three groups（P>0.05）.Among 271 patients with initial acute myocardial infarction,116（42.8%）were in the normal group and 155（57.2%）were in the pre-diabetic group.Patients with prediabetes were older than those in the normal group（P<0.05）,there were no significant differences in BMI,TC,LDL-c,HDL-c,fasting blood glucose,glomerular filtration rate,water hypertension and smoking ratio between the two groups（P>0.05）,suggesting no significant difference in baseline data between the two groups except age.Analysis of risk factors for ASCVD between the prediabetic group and the normal group:There was no significant difference in the number of risk factors between the two groups,suggesting that there was no significant difference in the distribution of risk factors between the two groups.2.Proportion of patients with prediabetes in the risk stratification of ASCVD:Among 271 AMI patients,patients with prediabetes accounted for 51.4%（38 cases）,46.2%（43 cases）and 72.1%（75 cases）in the low-risk,medium-risk and high-risk groups,respectively,and the difference between groups was statistically significant（P<0.05）.A pair comparison of the proportion of prediabetes among different ASCVD risk stratification groups showed that there were statistically significant differences in the proportion of prediabetes among high-risk groups,low-risk groups and intermediate-risk groups（P<0.05）,there was no significant difference in the proportion of patients with prediabetes between low-risk and middle-risk groups（P>0.05）.3.Prediabetes was taken as a risk factor to identify high-risk patients,and ASCVD risk was reclassified for low-risk patients.51.4%of low-risk patients were pre-diabetes patients,and 51.4%of low-risk patients were identified as high-risk patients.Among low-risk patients,the rate of failure to meet the cholesterol target before and after risk reclassification was 17.57%（13 cases）vs.37.84%（28 cases）,with statistical difference（P=0.01）.4.There were 10 patients（3.56%）with AMI whose LDL-c and TG levels were lower than the minimum threshold of the 10-year ASCVD scoring standard,so ASCVD scoring could not be performed,among which pre-diabetes accounted for 60%（6 cases）.Other risk factors smoking,low HDL-c,old age,hypertension,overweight,high TC, high LDL-c,chronic renal failure accounted for 70%（7 cases）,70%（7 cases）,60%（6cases）,20%（2 cases）,10%（1 case）,0%,0%,0%,respectively.Prediabetes ranked third among all risk factors,suggesting that it may be a useful marker for identifying patients at high risk of AMI in non-diabetic populations that could not be scored.If pre-diabetes is included as a risk factor for identifying patients at high risk of AMI,more patients with AMI may be identified before onset.Conclusions1.More than half of non-diabetic patients with first-episode acute myocardial infarction had low or medium-risk ASCVD risk assessment at the time of onset.2.Hb Alc levels may help reclassify the 10-year risk of ASCVD in low-risk non-diabetic populations.3.The inclusion of Hb Alc as a risk factor in the primary prevention risk assessment of ASCVD may identify more low-risk people in need of early lipid drug intervention. |
