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EDITORIALS: Elizabeth Barrett-Connor and Deborah L Wingard "Normal" blood glucose and coronary risk BMJ 2001; 322: 5-6 [Full text]

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Glucose Reduction and Cardiovascular Risk Factors

Ronald A Cameron   (11 January 2001)

Glucose Reduction and Cardiovascular Risk Factors 11 January 2001
Ronald A Cameron, University of Pennsylvania 37 Glendale Road, Upper Darby, PA 19082/USA Send response to journal: Re: Glucose Reduction and Cardiovascular Risk Factors	The recent editorial, _Normal blood glucose and coronary risk_ states "the evidence that glucose control prevents coronary heart disease is equivocal in patients with diabetes." It is indicated that this conclusion is unexpected, and several hypotheses are listed to explain the finding. Given the dates studies supporting these findings were initiated, it seems likely that "glucose control" in Type 2 diabetics was being primarily obtained by pharmacologically elevating insulin levels. If we assume many subjects in these experiments were at the outset in some stage of insulin resistance, is it not possible that the resulting therapeutic elevation of insulin levels was simply superimposed on the pre-existing absolute hyperinsulemia, making the problem more severe? While further elevation of insulin levels undoubtedly lowered serum glucose, it also may have sufficiently aggravated other cardiovascular risk factors (abnormal lipid profile, hypertension) to mask the benefits of glucose reduction. Of course, this could be alleviated by "aggressively treating" the resulting "hyperlipidemia and hypertension" as is also mentioned in the Editorial. Yours truly, Ronald A. Cameron, D.M.D., M.D.S.