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Methods In 10,310 participants from the Atherosclerosis Risk in Communities (ARIC) Study (aged 4670 years, ~55% women, ~20% Black adults) without diabetes at baseline (19901992), we used Cox regression to characterise age- and sex-adjusted associations of prediabetes with ~30 year incidence of complications (composite and separately), including atherosclerotic CVD (ASCVD), heart failure, chronic kidney disease (CKD) and all-cause mortality before and after accounting for intervening incidence of diabetes, modelled as a time-varying variable