Hyperglycemia As A Cardiovascular Risk Factor
posted 01/09/04
The presence of CHD (coronary heart disease) before the onset of clinical diabetes provides strong evidence for a strategy of diabetes prevention in at-risk patients.

Patients with type 2 diabetes mellitus have a 2- to 4-fold increased risk of coronary heart disease (CHD) and a 4-fold increase in mortality from CHD. Intensive glycemic control has a more modest effect on reducing macrovascular complications than microvascular complications. Most likely, this is because the development of cardiovascular disease is multifactorial, and hyperglycemia is 1 of many risk factors.

Epidemiologic data suggest that a glycosylated hemoglobin (A(1c)) level of < or =7% is reasonable to avoid or minimize the complications associated with type 2 diabetes. Studies have shown that there is an increased risk of cardiovascular mortality before the onset of type 2 diabetes.

Data indicate that the atherogenic pattern of changes in the prediabetic state is seen primarily in insulin-resistant patients rather than in those with abnormally low insulin secretion. Therefore, strategies to prevent or treat type 2 diabetes should focus on improving insulin sensitivity. Clinical trials have demonstrated that lifestyle changes (e.g., diet and exercise) as well as use of metformin, acarbose, or a glitazone reduce the incidence of type 2 diabetes. Prevention of type 2 diabetes may be an important strategy to delay or prevent cardiovascular disease in many individuals.

Source: Diabetes In Control.com: Am J Med. 2003 Dec 8;115 Suppl 8A:6S-11S60015600156.

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