The role of glucose as an independent cardiovascular risk factor.

The role of hyperglycemia as an independent risk factor for the development of atherosclerosis and CVD is strongly suggested by data from large epidemiologic studies as well as by numerous clinical trials. However, the specific roles of elevated fasting plasma glucose, postprandial glucose levels, and average blood glucose as measured by glycosylated hemoglobin (HbA(1c)) are less clear. Population studies and clinical trials addressing these issues have been reviewed with the conclusion that HbA(1c) is an independent risk factor for CVD in both diabetic and nondiabetic subjects. There is also strong evidence that postchallenge plasma glucose levels independently predict CVD events, whereas the evidence that fasting plasma glucose levels are predictive is much weaker. The implications for treatment are that targets for HbA(1c) and postprandial glucose levels are important to achieve, not only to reduce the risk of microvascular complications, but also to reduce the risk of CVD morbidity and mortality in people with diabetes.