Doctors and nutritionists have traditionally based efforts to reduce cardiovascular mortality on three fundamental pillars: controlling blood pressure, reducing LDL cholesterol and quitting smoking.
Now, new research from the University Hospital of Tübingen, Helmholtz in Munich and the German Center for Diabetes Research (DZD) proposes adding a fourth element: the persistent normalization of blood pressure. glycemia in the prediabetes phase.
An international analysis has shown, for the first time, that people with prediabetes who manage to normalize their blood glucose levels through lifestyle changes can reduce their risk of heart attack, heart failure and premature death by half. This finding, described as potentially revolutionary in the field of medical prevention, opens the door to incorporating a new measurable objective in clinical guidelines.
The teacher Andreas Birkenfeldexplains: “Our results suggest that remission of prediabetes not only delays or prevents the onset of type 2 diabetes, as was already known, but also protects people against serious cardiovascular diseases for decades.”
Prediabetes is considered an early phase of diabetes and until now lacked well-defined therapeutic goals. Although those affected are often advised to lose weightimprove your feeding and increase the physical activityit was unclear whether these efforts translated into long-term cardiovascular benefits. Until now, no lifestyle program aimed at this group had shown a sustained reduction in events such as heart attacks or heart-related deaths over decades.
The key, glucose levels
The recent advance comes from a combined analysis of two of the largest diabetes prevention studies in the world, conducted in the United States and China. Under the coordination of the Tübingen team and with the collaboration of international colleagues, it was examined whether the key was not simply the change of habits, but the effective achievement of normalization of glucose levels, that is, the remission of prediabetes.
Long-term data, collected from more than 2,400 people with prediabetes, reveal that those who managed to return to normal blood glucose levels had a much lower risk of suffering serious cardiovascular events or dying from these causes, even when weight loss was similar between the groups compared. In both studies, the cardiovascular mortality was reduced by around 50%, and overall mortality also showed a significant decrease. Specifically, follow-up in the United States lasted for 20 years, while in China it lasted 30. The data were subsequently harmonized to facilitate a comparative analysis between the groups with and without remission of prediabetes.
According to the study, a value of fasting glucose equal to or less than 97 mg/dL It is a simple threshold that can indicate a significantly lower risk of cardiovascular disease, regardless of age, weight or ethnicity. This measure could easily be implemented in primary care medical practices around the world, facilitating more effective and accessible prevention.
The study ultimately highlights the value of establishing clear and measurable objectives in the field of prevention. «We see a clear therapeutic window: if glucose levels are normalized already in the prediabetes stage, the long-term risk of heart attack, heart failure and premature death can be significantly reduced. “Our data explicitly support the inclusion of remission as a primary treatment goal in guidelines for the prevention of diabetes and cardiovascular disease,” Professor Birkenfeld concluded.
