To assess the risk of major adverse cardiovascular events (MACE), all-cause mortality, and initiation of medical treatment in subjects with prediabetes according to first-time measured HbA_1c.

Through registry databases, we identified 326,305 Danish patients with a first HbA_1c between 40 and 51 mmol/mol (5.8–6.8%) from 2011 to 2017. After exclusion of patients with prior disease, 84,678 patients were followed 12 months after first HbA_1c measurement. Cox regression models were used to estimate hazard ratios (HRs) of MACE and standardized absolute risks. Cumulative incidences were used to analyze initiation of glucose-lowering, antihypertensive, cholesterol-lowering, and antithrombotic medication.

The 12-month risk of MACE and all-cause mortality increased gradually with increasing HbA_1c until 47 mmol/mol (6.5%). In comparisons of subjects with HbA_1c 40–41 mmol/mol (5.8–5.9%), subjects with HbA_1c 46–47 mmol/mol (6.4–6.5%) had a 0.79% (95% CI 0.33–1.24) higher standardized absolute risk and an HR of 2.21 (95% CI 1.67–2.92) of MACE. Patients with HbA_1c 48–49 mmol/mol (6.5–6.6%) had a 0.09% (95% CI –0.35 to 0.52) lower absolute risk and an HR of 1.33 (95% CI 0.87–2.05) of MACE. Initiation of medication was significantly lower among patients with HbA_1c of 46–47 mmol/mol (6.4–6.5%) than among patients with HbA_1c of 48–49 mmol/mol (6.5–6.6%).

In the Danish population screened for diabetes with HbA_1c, the highest risk of MACE and all-cause mortality was found in subjects with HbA_1c just below the diagnostic threshold for diabetes. Our results highlight the need for increased focus on the treatment of cardiovascular risk factors for subjects with prediabetes.

根据首次测量的 HbA _1c评估糖尿病前期受试者的主要不良心血管事件 (MACE)、全因死亡率和开始药物治疗的风险。

通过注册数据库，我们确定了 2011 年至 2017 年 326,305 名丹麦患者的首次 HbA _1c介于 40 和 51 mmol/mol (5.8-6.8%) 之间。排除既往疾病患者后，在首次 HbA _1c后 12 个月对 84,678 名患者进行了随访测量。Cox 回归模型用于估计 MACE 的风险比 (HR) 和标准化绝对风险。累积发生率用于分析降糖、抗高血压、降胆固醇和抗血栓药物的启动情况。

_{随着 HbA 1c}增加到47 mmol/mol (6.5%) ，MACE 和全因死亡率的 12 个月风险逐渐增加。在 HbA _1c 40–41 mmol/mol (5.8–5.9%) 的受试者比较中，HbA _1c 46–47 mmol/mol (6.4–6.5%) 的受试者有 0.79% (95% CI 0.33–1.24) 更高的标准化MACE 的绝对风险和 HR 为 2.21 (95% CI 1.67–2.92)。HbA _1c 48–49 mmol/mol (6.5–6.6%) 的患者发生 MACE 的绝对风险降低 0.09% (95% CI –0.35 至 0.52)，HR 为 1.33 (95% CI 0.87–2.05)。_{HbA 1c}为 46–47 mmol/mol (6.4–6.5%) 的患者开始用药明显低于HbA _1c为 48–49 mmol/mol 的患者 (6.5–6.6%)。

在筛查 HbA 1c 糖尿病的丹麦人群中_{，发现 HbA 1c}刚好低于糖尿病诊断阈值的受试者发生 MACE 和全因死亡率的风险最高。我们的研究结果强调需要更加关注前驱糖尿病患者心血管危险因素的治疗。