Firstly, from a CVD risk reduction perspective I don’t treat patients with “prediabetes” (impaired fasting glucose or impaired glucose tolerance) differently from patients who have diabetes. I recommend the same lifestyle recommendations, and apply the same thresholds for starting ACE inhibitors, statins. Patients with either should be considered high risk unless they are of younger age (males < 45, females < 50), have a shorter duration of diabetes, lack of other CVD risk factors, lack of complications and no extremes of BP or LDL-cholesterol.
Based on meta-analyses, the presence of metabolic syndrome increases the risk of CVD by 1.5 times. If using Framingham I would calculate the risk estimate, and then multiply by 1.5 to give a patient a numeric, albeit broad, estimate.
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