Understanding Prediabetes, An ‘Independent Risk Factor’ for Heart Disease

Prediabetes is prevalent, misunderstood and potentially serious on its own as an independent risk factor for heart disease, explain Baptist Health experts.

But many individuals may choose to ignore it – even if they know they have it.


Jonathan Fialkow, M.D., chief population health officer for Baptist Health and chief of cardiology at Miami Cardiac & Vascular Institute.

“Prediabetes is a diagnosis where your blood sugar levels are higher than normal, but not high enough to be considered diabetes,” explains Jonathan Fialkow, M.D., chief population health officer for Baptist Health and chief of cardiology at Miami Cardiac & Vascular Institute. “There are a lot of misconceptions and a general lack of concern around this condition because most people think they’re not there yet. They’re not yet diabetic. And while the good news is that this condition could be controlled — and even better — prevented, there’s still many implications and dangerous consequences if it’s not recognized, or if it’s ignored.”

Dr. Fialkow hosts a new Baptist HealthTalk Podcast: Understanding Prediabetes, with guest Lisa Davis, PA-C, certified clinical lipid specialist at Miami Cardiac & Vascular Institute and the Cardiology Group.

In the U.S., it is estimated that more than 1 in 3 adults are living with prediabetes, and more than 80 percent don’t even know they have it. Prediabetes can increase a person’s risk of developing type 2 diabetes, heart disease, and stroke. The majority of those diagnosed with prediabetes will progress to type 2 diabetes.

The A1C test is a common blood test used to diagnose prediabetes and diabetes. A normal A1C level is below 5.7 percent. A result between 5.7 and 6.4 percent is considered prediabetes, which indicates a high risk of developing diabetes. An A1C level of 6.5 percent or above on two separate occasions confirms the diagnosis of diabetes.

“It’s really important to be aware of that prediabetes itself has been found to be an independent risk factor for heart disease,” explains Ms. Davis. “Prediabetes is diagnosed when we see a fasting blood sugar between a 100 and 125 and a hemoglobin A1C at 5.7 to 6.4 percent. It’s very important to really have the awareness to screen for this because — even when you take out all other risk factors such as blood pressure and cholesterol — prediabetes itself remains a major a risk factor. Prediabetes can be associated with up to a 25 percent increased risk of having a heart attack.”

Prediabetes can be asymptomatic. So, diagnosing the condition can be a challenge. “Are there components of the body type or aspects that would identify someone who might be prediabetic, who should then get labs done?” asks Dr. Fialkow.

“We don’t expect patients to come in saying: ‘I’m feeling this. Therefore, screen me for prediabetes.’ Most people aren’t going to have any symptoms, but there are certain metabolic changes that we might notice in patients,” explains Ms. Davis. “They start having a little extra weight around the abdomen. Perhaps you notice that your blood pressure’s a little bit elevated. You may notice on a cholesterol panel, for example, you could start seeing the triglycerides are increased or your HDL (good cholesterol) is lower.”

Listen to the full Baptist HealthTalk podcast on prediabetes.

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