GLUCOSE - A CONTINUOUS RISK FACTOR FOR CARDIOVASCULAR-DISEASE

The glucose level that defines diabetes mellitus is that level above w hich patients have a high risk of eye, kidney, and neuronal disease. T he risk of these complications rises as glucose levels increase, and d ecreases as therapy brings the glucose level down. Thus, in patients w ith diabetes, glucose is a continuous, modifiable risk factor for eye, kidney and peripheral nerve disease. Plasma glucose concentrations in the diabetic range are also a continuous risk factor for cardiovascul ar disease (CVD). Moreover, epidemiological evidence shows that the re lationship between plasma glucose concentration and CVD extends well b elow the glucose level defined for diabetes and even impaired glucose tolerance. This continuous relationship between glucose and CVD exists in all people, not just in those with a defined metabolic disease, an d is therefore similar to the relationship between cholesterol or bloo d pressure and CVD. It may be secondary to either a direct effect of e levated glucose or to some underlying metabolic abnormality that raise s both glucose and cardiovascular risk. Whether interventions that low er glucose will also lower the risk of CVD is still unknown; the resul ts of clinical trials are awaited. (C) 1997 by John Wiley & Sons, Ltd.