Postprandial Glucose: Marker or Risk Factor?

Abstract

Postprandial glucose (PPG) has a noxious effect on the vascular endothelium, which is mainly mediated by oxidative stress. This condition leads to endothelial activation and dysfunction, two prerequisites for the onset of cardiovascular disease (CVD) (1). The importance of PPG is reflected in the creation of guidelines by the International Diabetes Federation (IDF) for the management of postmeal glucose (http://www.idf.org/guidelines/postmeal-glucose). In these guidelines, the statement “Postmeal and postchallenge hyperglycaemia are independent risk factors for macrovascular disease” was rated as Level 1+, i.e., the data were derived from well-conducted meta-analyses, systematic reviews of randomized controlled trials (RCTs), or RCTs with a low risk of bias. The relationship between postchallenge hyperglycemia and CVD has been addressed by several studies. In the Honolulu Heart Program, the risk of coronary heart disease was increased in Japanese American men aged 45–68 years who had an abnormal oral glucose tolerance test (2). Comparable results were observed in the Chicago Heart Association Detection Project in Industry Study (3), the Paris Prospective Study (4), the Baltimore Longitudinal Study of Aging (5), and the Diabetes Epidemiology: Collaborative Analysis of Diagnostic Criteria in Europe (DECODE) study (6). Furthermore, two meta-analyses provided evidence that hyperglycemia in the nondiabetic range was associated with a higher risk of fatal and nonfatal CVD. They also showed that CVD events increased linearly, with no threshold, along with 2-h postmeal plasma glucose levels (7,8). Relatively few studies have analyzed postmeal hyperglycemia as a risk factor in CVD development. In the Diabetes Intervention Study (DIS), in type 2 diabetic patients who were monitored for 11 years, postbreakfast glucose levels, rather than fasting glucose, were related to myocardial infarction and death (9). In this issue of Diabetes Care , Cavalot et al. (10) add further evidence of the harmful relationship between postmeal glucose levels and …