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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2003;23:917.)
© 2003 American Heart Association, Inc.

Editorials

Type 2 Diabetes and Coronary Heart Disease

We Keep Learning How Little We Know

Gerald Reaven

From the Department of Medicine, Stanford University School of Medicine, Calif.

Correspondence to Gerald Reaven, MD, Falk CVRC, Stanford Medical Center, 300 Pasteur Dr, Stanford, CA 94305. E-mail greaven@cvmed.stanford.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Although it has been apparent for some time that coronary heart disease (CHD) is the major cause of morbidity and mortality in patients with type 2 diabetes, we do not seem to be gaining much ground in our efforts to understand either why this is the case or how best to prevent it. The dilemma was made explicit by the results of the United Kingdom Prospective Diabetes Study (UKPDS) showing that improvement in glycemic control was much more effective in reducing the microvascular complications of type 2 diabetes than it was in decreasing CHD.¹ A subsequent analysis of the UKPDS data emphasized these differences in outcome by directly demonstrating that the impact of better glycemic control on incidence of CHD was strikingly attenuated as compared with the robust improvement in microvascular disease.² The report by Wagenknecht and associates³ in this issue of Arteriosclerosis, Thrombosis, and Vascular Biology serves to both emphasize the magnitude of the problem as well as point out that the solution does not necessarily result from greatly increasing the number of CHD risk factors measured.

See page 1035

The study by Wagenknecht and colleagues³ involved ultrasound evaluation of the progression over 5 years of carotid artery thickening in 1192 individuals, 336 of whom had type 2 diabetes at baseline, either undiagnosed (n=138) or diagnosed (228). Unfortunately, we are not told whether any of the participants developed clinical evidence of CHD during the 5-year period of observation. However, 40 deaths did occur, and the mortality rate was highest . . . [Full Text of this Article]