Silent coronary artery disease and incidence of cardiovascular and mortality events at different levels of glucose regulation; results of greater than a decade follow-up

•Gender significantly modified the impact of silent coronary artery disease (CAD) in different categories of glucose tolerance status for incident CVD/CHD and mortality events.•The presence of silent CAD, among female population with normal fasting glucose and normal glucose tolerance (NFG/NGT) or pre diabetes, significantly increased the risk of CVD/CHD.•Among new diagnosed diabetes mellitus (NDM) male population silent CAD was a significant risk for CVD and mortality events.•Different strategies should be considered for males and females with silent CAD in different level of glucose tolerance.

BackgroundTo determine the impact of silent coronary artery disease (CAD), in different levels of glucose regulation at baseline, i.e., those with normal fasting glucose/normal glucose tolerance (NFG/NGT), pre-diabetic and newly diagnosed diabetes mellitus (NDM), on cardiovascular disease (CVD) and total mortality in Iranian populations.MethodsThe study population included 1809 individuals, aged ≥ 50 years, free of CVD at baseline with a median follow-up of 12.1 years. To explore the risk of CVD and mortality associated with the presence of silent CAD (as defined by Minnesota coding criteria for baseline electrocardiogram (ECG) in the absence of a history of CVD) in each of the glucose regulation categories, multivariate adjusted hazard ratios (HRs) were calculated for the presence of silent CAD, compared to the corresponding non-silent CAD counterpart, as reference.ResultsDuring follow-up 382 CVD (321 coronary heart disease) and 208 deaths (91 CVD mortality) occurred. Among the female population, the presence of silent CAD, independent of traditional risk factors, significantly increased the risk of CVD for population with NFG/NGT [2.40 (1.33-4.35)] and pre-diabetes [HR: 2.04 (1.14-3.63)]; however, in the male population the risk was significant for CVD [3.04 (1.53-6.05)] and mortality events [2.60 (1.22-5.56)] in the NDM population and marginally significant for mortality events in NFG/NGT.ConclusionDifferent strategies should be considered for silent CAD in males and females with different levels of glucose regulation. It might be justified that screening ECG for prevention of CVD events should be considered mainly among non-diabetic women and men with NDM.