From the Guidelines
No, pre-diabetes does not count as diabetes in the Atherosclerotic Cardiovascular Disease (ASCVD) calculator. The ASCVD risk calculator specifically requires the presence of diagnosed diabetes mellitus (typically Type 1 or Type 2) as a binary yes/no input, and pre-diabetes does not meet this threshold. Pre-diabetes, characterized by elevated blood glucose levels that are not yet high enough to be classified as diabetes (typically HbA1c of 5.7-6.4% or fasting glucose of 100-125 mg/dL), represents an intermediate state of hyperglycemia. While pre-diabetes does increase cardiovascular risk compared to normal glycemic status, the ASCVD calculator was validated using diabetes as a distinct risk factor, as noted in the most recent guidelines 1. When using the calculator for someone with pre-diabetes, you should select "no" for the diabetes question. However, it's essential to recognize that the calculated risk score may underestimate the actual cardiovascular risk in pre-diabetic patients, as their risk falls somewhere between those with normal glucose metabolism and those with diabetes. Some key points to consider include:
- The ASCVD risk calculator is a useful tool for estimating 10-year ASCVD risk, but it has limitations, such as not accounting for the duration of diabetes or the presence of diabetes complications 1.
- Pre-diabetes is associated with an increased risk of cardiovascular disease, but the calculator does not specifically account for this condition 1.
- Clinicians should consider the limitations of the calculator when interpreting results and making treatment decisions for patients with pre-diabetes. Given the most recent evidence, the ASCVD calculator should be used with caution in patients with pre-diabetes, and clinicians should consider additional risk factors and individual patient characteristics when making treatment decisions.
From the Research
Pre-diabetes and ASCVD Calculator
- Pre-diabetes is a condition where blood sugar levels are higher than normal but not high enough to be classified as diabetes 2.
- The Atherosclerotic Cardiovascular Disease (ASCVD) calculator is used to determine the risk of ASCVD in patients, and it takes into account various factors such as age, sex, race, total cholesterol, HDL-C, systolic blood pressure, and history of diabetes 3.
- According to the studies, pre-diabetes is related to an increased risk of CAD, including cardiovascular events, and is considered a metabolic risk factor for developing ASCVD and type 2 diabetes mellitus (T2DM) 2, 4.
- The ASCVD calculator does not specifically mention pre-diabetes as a separate category, but rather considers a history of diabetes as one of the risk factors 3.
- However, given the accumulating evidence that pre-diabetes is also related to increasing risk of CAD, it is likely that pre-diabetes would be considered a risk factor for ASCVD, although it may not be explicitly stated in the calculator 2, 4.
- A study suggests that individuals with prediabetes should be tested at least annually for progression to diabetes and referred to intensive diet and physical activity behavioral counseling programs 4.
- Another study found that the QRISK 3® and ASCVD scores can be used to triage patients who require further evaluation with coronary artery calcium scores to determine the risk of future CVD, and that a QRISK® score >23 and ASCVD score >10 predicted a coronary artery calcium score >100 with sensitivities of 85% and 90%, respectively 5.
Key Factors
- Age, sex, race, total cholesterol, HDL-C, systolic blood pressure, and history of diabetes are considered in the ASCVD calculator 3.
- Pre-diabetes is a metabolic risk factor for developing ASCVD and T2DM 2, 4.
- Lifestyle management, including a heart-healthy dietary pattern and physical activity, is recommended for primary prevention of ASCVD and T2DM 4.