Diabetes, prediabetes, and cardiovascular risk: shifting the paradigm.
As the prevalence of diabetes continues to increase worldwide, diabetes-related macrovascular morbidity and mortality are becoming major health care problems. Epidemiologic evidence suggests this relationship begins early in the progression from normal glucose tolerance to frank diabetes. This report reviews this epidemiologic evidence linking early stages of glucose dysregulation with cardiovascular disease and discusses the results of major clinical trials demonstrating that lifestyle or pharmacologic intervention can reduce the incidence of diabetes in high-risk individuals. These observations indicate that early identification and aggressive treatment of subjects with impaired fasting glucose or impaired glucose tolerance have the potential to reduce both the incidence of diabetes and its related cardiovascular disease. Three clinical trials are being conducted to test whether early pharmacotherapy can reduce or delay the incidence of diabetes, and their results may well begin to shift the treatment paradigm toward earlier intervention.
Deedwania
Prakash C
PC
Division of Cardiology, Department of Medicine, Veterans Affairs Central California Health Care System, University of California San Francisco Medical Education Program, Fresno, 93703, USA. deed@fresno.ucsf.edu
Fonseca
Vivian A
VA
D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D019440:Anti-Obesity Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D015444:Exercise; D018149:Glucose Intolerance / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008019:Life Style
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D019440:Anti-Obesity Agents; D007004:Hypoglycemic Agents