Diabetes, prediabetes, and cardiovascular risk: Shifting the paradigm

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Diabetes, prediabetes, and cardiovascular risk: Shifting the paradigm Prakash C. Deedwania, MD, Vivian A. Fonseca, MD The American Journal of Medicine Volume 118, Issue 9, Pages 939-947 (September 2005) DOI: 10.1016/j.amjmed.2005.05.018 Copyright © 2005 Elsevier Inc. Terms and Conditions

Figure 1 Adjusted risk of cardiovascular death associated with 2-hour post-challenge glucose and fasting plasma glucose using previously diagnosed diabetes as the reference category. The hazard ratio was adjusted for age, sex, study, body mass index, systolic blood pressure, cholesterol, and smoking.17 DM, diabetes mellitus; CI, confidence interval. The American Journal of Medicine 2005 118, 939-947DOI: (10.1016/j.amjmed.2005.05.018) Copyright © 2005 Elsevier Inc. Terms and Conditions

Figure 2 Endothelial-dependent diameter increases of the brachial artery are decreased in subjects at high risk for diabetes, with impaired glucose tolerance or diabetes compared with control subjects.27 *P < .01 compared with control group. “Relative” indicates subjects with normal glucose tolerance (NGT) who were at high risk of developing diabetes because their parent or parents have diabetes. IGT, impaired glucose tolerance; SE, standard error; SD, standard deviation. The American Journal of Medicine 2005 118, 939-947DOI: (10.1016/j.amjmed.2005.05.018) Copyright © 2005 Elsevier Inc. Terms and Conditions

Figure 3 Age-adjusted relative risk of future coronary heart disease events according to baseline CRP and LDL cholesterol in 27939 women participating in the Women’s Health Study.40 Qualifying cardiovascular events included nonfatal myocardial infarction, nonfatal ischemic stroke, coronary revascularization procedures, and death from cardiovascular causes. LDL, low-density lipoprotein; CRP, C-reactive protein. The American Journal of Medicine 2005 118, 939-947DOI: (10.1016/j.amjmed.2005.05.018) Copyright © 2005 Elsevier Inc. Terms and Conditions

Figure 4 Intensive lifestyle intervention reduces the incidence of type 2 diabetes in high-risk individuals. The relative risk of incident diabetes in the intervention group compared with the control group was 0.4 (P < .001).44 CI, confidence interval. The American Journal of Medicine 2005 118, 939-947DOI: (10.1016/j.amjmed.2005.05.018) Copyright © 2005 Elsevier Inc. Terms and Conditions

Figure 5 Effect of metformin or intensive lifestyle modification on the incidence of diabetes in high-risk individuals. The incidence of diabetes was significantly different between the 3 groups (P < .001 for each comparison).48 The American Journal of Medicine 2005 118, 939-947DOI: (10.1016/j.amjmed.2005.05.018) Copyright © 2005 Elsevier Inc. Terms and Conditions