High cardiovascular disease risk-associated with the incidence of Type 2 diabetes among prediabetics

Eur J Intern Med. 2022 Dec:106:56-62. doi: 10.1016/j.ejim.2022.09.005. Epub 2022 Sep 22.


Background: Prediabetes is a risk factor for developing Type 2 diabetes mellitus (T2D). We report on the first cohort study of the association between high cardiovascular diseases (CVD) risk with the incidence of T2D in prediabetics. First, estimate the direct effect of developing T2D on patients with prediabetes who have high CVDs risk; and 2) assess the potential increased risk of developing T2D mediated by statins.

Methods: We conducted a population-based cohort study using a subset of data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) from 2000 to 2015. Cox proportional hazards (PH) regressions were conducted to estimate our primary outcome, which is the time to T2D among patients with prediabetes.

Results: From the 4995 filtered prediabetic participants identified between 2000 and 2015, 2800 participants were diagnosed with high CVDs risk scores as measured by the Framingham risk score. 2195 participants were non-high CVDs risk controls. The covariate-adjusted hazard ratio (HR) of 1.24 [95% confidence interval (CI), 1.10-1.31] for T2D by CVDs risk among prediabetics was observed. The total effect of CVDs risk on developing T2D was decomposed to a natural direct effect of high CVDs risk HR= 1.18 [95% CI, 1.01-1.48] and an indirect effect through statin therapy of HR= 1.06 [95% CI, 0.97-1.30].

Conclusion: Patients with prediabetes and high CVDs risk had a 24% higher chance of developing T2D. The high CVDs risk effect was mediated by statin therapy. Regular monitoring and counselling of prediabetics using statins is likely warranted to prevent the incidence of T2D.

Keywords: Cardiovascular disease; Causal mediation analysis; Diabetes; Prediabetes; Statin.

MeSH terms

  • Canada / epidemiology
  • Cardiovascular Diseases* / complications
  • Cardiovascular Diseases* / epidemiology
  • Cohort Studies
  • Diabetes Mellitus, Type 2* / epidemiology
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors* / therapeutic use
  • Incidence
  • Prediabetic State* / epidemiology
  • Prediabetic State* / prevention & control
  • Risk Factors


  • Hydroxymethylglutaryl-CoA Reductase Inhibitors