Dysglycaemia: a cardiovascular risk factor

Patients with diabetes have a 2-fold higher risk of developing cardiovascular disease than non-diabetic individuals. Moreover, recent epidemiologic studies have shown that this risk rises with the degree of hyperglycaemia, so that diabetic patients with poorly controlled glucose levels have a higher risk of cardiovascular disease than those with well-controlled glucose levels. Thus, in patients with diabetes, glucose level appears to be a continuous risk factor for cardiovascular disease. Several epidemiologic studies also suggest that this relationship is not confined to the diabetic range; non-diabetic levels of fasting and postprandial hyperglycaemia, that may even be lower than those associated with impaired glucose tolerance, are also associated with an increased risk of cardiovascular disease. Evidence is therefore accumulating that dysglycaemia (i.e. raised glucose levels above some low, as yet undefined, threshold) is a continuous risk factor for cardiovascular disease. This relationship is similar to that of smoking, blood pressure and dyslipidaemia to cardiovascular risk. Whether glucose lowering in diabetic or non-diabetic individuals will prevent cardiovascular disease remains to be determined.