Sánchez E, Betriu A, López-Cano C, et al. - In view of the recent association of prediabetes with the subclinical atheromatous disease in the middle-aged population, researchers sought to report on atheromatous plaque burden by the number of affected territories and the total plaque area in the prediabetes stage. They examined 6,688 non-diabetic middle-aged individuals without cardiovascular disease for atheromatous plaque burden (quantity of plaques and total plaque area) in 12 territories from the carotid and femoral regions using ultrasonography. Glycosylated hemoglobin (HbA1c) between 5.7 and 6.4% according to the American Diabetes Association guidelines defined prediabetes. The diagnosis of prediabetes was made in 33.9% (n = 2,269) of the ILERVAS participants. Prediabetes individuals with HbA1c < 5.7% exhibited a higher prevalence of the subclinical atheromatous disease relative to those with HbA1c < 5.7%. This was observed at the level of the carotid territory, but not in the femoral arteries in the population with prediabetes. Further, a significantly higher number of affected territories were noted among participants in the prediabetes stage, with a positive correlation between HbA1c levels and the number of affected territories. Only in the presence of other cardiovascular risk factors, the prediabetes stage is accompanied by an enhanced subclinical atheromatous disease. In the presence of prediabetes modulation of the atherogenic effect of cardiovascular risk factors was observed in terms of distribution and total plaque area in a gender-dependent manner.