Prediabetes is associated with increased cardiometabolic burden, yet its independent contribution to cardiovascular disease (CVD) risk remains incompletely defined. This analysis published in the European Journal of Preventive Cardiology, utilized 20-year follow-up data (2002-2022) from the ATTICA study, a population-based prospective cohort conducted in a rural population in the greater Athens area, Greece, to examine the association between impaired fasting glucose (IFG) and incident CVD.

A total of 1,796 adults without baseline CVD or type 2 diabetes (T2D) were included. Among them, 333 individuals (18.5%) had IFG, while 1,463 (81.5%) had normal fasting glucose (NFG). Incident fatal and non-fatal CVD events were recorded over the follow-up period. Cox proportional hazards models were applied to evaluate the independent association between IFG and CVD outcomes.

During 20 years of follow-up, all individuals with IFG developed T2D, compared with 13.5% of those with NFG (p<0.001). The cumulative incidence of CVD was significantly higher in the IFG group than in the NFG group (40.2% vs. 30.2%, p=0.001). 
In multivariable analyses, IFG independently predicted CVD events (hazard ratio [HR] 1.21; 95% confidence interval [CI] 1.01-1.48; p=0.038). Landmark analyses further demonstrated that earlier onset of T2D (before 10 years) was associated with increased subsequent CVD risk (adjusted odds ratio 2.46; p<0.05).

These findings indicate that IFG is independently associated with long-term CVD risk. Earlier progression to T2D was associated with higher cardiovascular risk over time.