%0 Journal Article
%T The Sweet Spot: Continued Search for the Glycemic Threshold for Macrovascular Disease¡ªA Retrospective Single Center Experience
%A Andrzej Boguszewski
%A Andrew Teklinski
%A Howard Rosman
%A Devang Desai
%A Sajid Ali
%A Susan Szpunar
%A Ruth Moore
%A James Maciejko
%J ISRN Cardiology
%D 2012
%R 10.5402/2012/874706
%X Background. Atherosclerotic cardiovascular disease (ASCVD) is a common complication of diabetes mellitus and impaired fasting glucose (IFG). We hypothesized that the relation of fasting glucose levels to ASCVD is linear, with the prevalence of clinical ASCVD beginning to increase even among individuals currently categorized as normoglycemic. Methods. Patient charts were retrospectively reviewed from our Dyslipidemic Preventive Cardiology Clinic. We evaluated the prevalence of ASCVD relative to fasting glucose levels in a cross-section of patients at high risk for ASCVD. Results. In 558 dyslipidemic patients, ASCVD prevalence increased with increasing fasting glucose levels. A significantly higher prevalence of ASCVD was observed among patients with fasting glucose levels between 90 and 99£¿mg/dL versus lower levels. As glucose levels increased from 90 to 125£¿mg/dL, the prevalence of ASCVD continued to rise in parallel. Logistic regression analysis with forward likelihood ratio stepwise selection indicated that individuals with fasting blood glucose of 90¨C99£¿mg/dL were 2.6 times more likely to have ASCVD than those with lower levels of fasting blood glucose. Conclusion. Our findings suggest that the current cutoff for impaired fasting glucose of 100£¿mg/dL may be somewhat conservative and that a level above 90£¿mg/dL may be more appropriate as an ASCVD risk factor, particularly in patients with a lipid disorder. 1. Introduction Atherosclerotic cardiovascular disease (ASCVD) is a common complication of diabetes mellitus (DM). Atherosclerosis is the primary reason for the decreased life expectancy of a newly diagnosed diabetic compared to an age and gender-matched nondiabetic [1, 2]. The risk of having a myocardial infarction over a period of seven years in the middle-aged diabetic patient without identified preexisting coronary heart disease (CHD) is the same as that in nondiabetic individual with existing CHD [3]. It is generally accepted that improved glycemic control decreases the onset and progression of microvascular complications, including nephropathy and retinopathy, and yet it does not reduce the risk of ASCVD and all-cause mortality [4, 5]. In the Prospective Pioglitazone Clinical Trial in macrovascular events (PROActive) study, however, improved glycemic control with pioglitazone reduced the composite endpoint of all-cause mortality, nonfatal myocardial infarction, and stroke in patients with type-2 diabetes and atherosclerosis [6]. In part, this may be due to the favorable effect of pioglitazone on the high-density lipoprotein (HDL),
%U http://www.hindawi.com/journals/isrn.cardiology/2012/874706/