Zhao Xinlong, Zhuang Yuansong, Tang Siqi, Ruan Yanping, Li Quan, Liu Yanbo, Lei Jinyan, Han Yitao, Chen Yuxiong, Zhao Yakun, Fan Zhongjie
Department of Cardiology, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China.
Department of Internal Medicine, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China.
Diabetol Metab Syndr. 2025 Mar 18;17(1):90. doi: 10.1186/s13098-025-01662-3.
Prediabetes (pre-DM) is recognized as an intermediate state of glucose metabolism with a high potential to progress to diabetes mellitus (DM). However, its prognostic value in patients with premature acute myocardial infarction (PAMI) under the age of 35 remains unclear. This study aimed to investigate the relationship between pre-DM and long-term cardiovascular outcomes in this unique population.
This retrospective cohort study included 796 PAMI patients under 35 years of age who were categorized into three groups based to glycated hemoglobin levels or previous history: normal glucose regulation (NGR), pre-DM, and DM. The primary endpoint was the occurrence of major adverse cardiovascular and cerebrovascular events (MACCE) including all-cause death, non-fatal myocardial infarction, non-fatal stroke, or revascularization. Multivariable Cox regression, Kaplan-Meier and Subgroup analyses were performed.
Pre-DM was observed in 22.1% of the PAMI cohort. During the median follow-up of 81 months, the incidence of MACCE was 23.5%, with significantly higher rates in the pre-DM and DM group compared to the NGR group (18.4%, 27.3%, 34.2%; p < 0.001). After adjusting for confounding variables, pre-DM remained independently associated with an increased risk of MACCE (HR 1.51, 95%CI 1.05-2.18, p = 0.027). Subgroup analysis demonstrated that pre-DM status was a robust risk factor compared to NGR. Moreover, pre-DM had a similar impact on MACCE events as DM in patients with PAMI.
Pre-DM is associated with a poor prognosis in young AMI patients under 35 years old, suggesting that it may be an independent predictor of adverse events in this population.
糖尿病前期（pre-DM）被认为是糖代谢的一种中间状态，具有进展为糖尿病（DM）的高风险。然而，其在35岁以下的早发急性心肌梗死（PAMI）患者中的预后价值仍不清楚。本研究旨在探讨这一特殊人群中糖尿病前期与长期心血管结局之间的关系。
这项回顾性队列研究纳入了796例35岁以下的PAMI患者，根据糖化血红蛋白水平或既往病史将其分为三组：血糖正常调节（NGR）、糖尿病前期和糖尿病。主要终点是主要不良心血管和脑血管事件（MACCE）的发生，包括全因死亡、非致命性心肌梗死、非致命性卒中或血运重建。进行了多变量Cox回归、Kaplan-Meier和亚组分析。
在PAMI队列中，22.1%的患者为糖尿病前期。在中位随访81个月期间，MACCE的发生率为23.5%，糖尿病前期和糖尿病组的发生率显著高于NGR组（18.4%、27.3%、34.2%；p<0.001）。在调整混杂变量后，糖尿病前期仍与MACCE风险增加独立相关（HR 1.51，95%CI 1.05-2.18，p=0.027）。亚组分析表明，与NGR相比，糖尿病前期状态是一个强有力的危险因素。此外，在PAMI患者中，糖尿病前期对MACCE事件的影响与糖尿病相似。
糖尿病前期与35岁以下年轻AMI患者的不良预后相关，提示其可能是该人群不良事件的独立预测因素。
