TOPLINE:

Over the course of 20 years, people with impaired fasting glucose levels were more likely to develop type 2 diabetes (T2D) and had a higher risk for cardiovascular disease (CVD), with earlier progression to T2D linked to an especially greater risk.

METHODOLOGY:

• Researchers used 2002-2022 data from a Greek prospective cohort (ATTICA) to examine whether impaired fasting glucose predicted 20-year cardiovascular outcomes.
• They included 1796 adults who were free of CVD and T2D at baseline (mean age range, 43.2-45.8 years; 45.4%-65.2% men).
• Impaired fasting glucose was defined as having fasting glucose levels of 100-125 mg/dL as per the diagnostic criteria for prediabetes. Overall, 18.5% of participants had impaired fasting glucose levels, and the remaining had normal fasting glucose levels.
• The onset of T2D was defined as fasting blood glucose levels ≥ 126 mg/dL or the initiation of antidiabetic treatment.
• Incident fatal or non-fatal CVD events were recorded over a follow-up duration of 20 years.

TAKEAWAY:

• Over 20 years, all participants with impaired fasting glucose levels vs 13.5% of those with normal fasting glucose levels developed T2D (P < .001).
• CVD occurred in 32.1% of participants overall. The incidence was higher among those with impaired vs normal fasting glucose levels (40.2% vs 30.2%; P = .001).
• Impaired fasting glucose was independently associated with a 21% increased risk for CVD (P = .038). Other independent predictors included higher age, male sex, and hypercholesterolaemia (P < .001 for all).
• Participants who developed T2D by year 10 had a higher risk for CVD than those who developed T2D at 20 years (adjusted odds ratio, 2.46; P < .05).

IN PRACTICE:

"[The study] findings underscore the need to recognize prediabetes as both a metabolic abnormality and a CVD risk factor, emphasizing the imperative for preventive and possibly therapeutic interventions to reduce the burden of the disease," the researchers of the study wrote.

SOURCE:

This study was led by Andria Papazachariou, University of Crete, Heraklion, Greece. It was published online on March 23, 2026, in the European Journal of Preventive Cardiology.

LIMITATIONS:

Some participants were lost to follow‑up. The study included only one fasting plasma glucose measurement. Data on medications, sleep, psychosocial factors, and detailed lifestyle were missing.

DISCLOSURES:

This study did not receive any specific funding. The ATTICA study received funding from the Hellenic Society of Cardiology and the Hellenic Atherosclerosis Society. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.