Consultant Department of Medicine, St. Mary Medical Center and Community Healthcare Systems. Program Director, Pinnacle Healthcare Systems. Medical Director, Northwest Indiana Medical Consultants PC. Assistant Professor of Medicine, Indiana University Sch
The benefits of angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) beyond blood pressure reduction have been proven through many large studies (HOPE, LIFE) in high risk CVD patients;1 post hoc studies have shown reductions in new onset type 2 diabetes mellitus (DM). However, there are no studies which revealed a strong correlation between impaired fasting glucose (IFG) and cardiovascular disease (CVD); instead, there were correlations with post challenge glucose and post challenge insulin levels. Insulin resistance (IR) is fundamental to high risk CVD situations and high fasting and post challenge insulin levels are surrogate markers for IR, albeit inconsistently. A logical approach to the prevention of type 2 DM and CVD must be therapeutic insulin reduction. Type 2 DM clearly influences the incidence of poor outcomes in CVD patients, and for any level of risk factors analyzed, a mechanism or mechanisms unique to or heavily represented by type 2 DM/impaired glucose tolerance (IGT)/IFG/metabolic syndrome (MetS) makes subjects more prone to CVD.2 Hyperglycemia is the most prevalent feature in DM, hence it is reasonable to assume that it is an independent risk factor for CVD which could be controlled by euglycemia.