Postprandial Hyperglycemia and Cardiovascular Disease

Abstract

In the recent HEART2D (Hyperglycemia and its Effect After Acute Myocardial Infarction on Cardiovascular Outcomes in Patients with Type 2 Diabetes Mellitus) study, published in this issue of Diabetes Care , Raz et al. (1) try to answer a hotly debated question of the last 10 years: is postprandial hyperglycemia an independent risk factor for cardiovascular disease in diabetes? This question, highlighted recently, has arisen because of the identified linear relationship, widely confirmed in many studies, between the risk of cardiovascular disease death and 2-h oral glucose tolerance test values (2). Consistent with these past results, a recent study has confirmed postprandial hyperglycemia as an independent risk factor for cardiovascular disease in type 2 diabetes (3). At the same time, in the STOP-NIDDM Trial it has been shown, as a predefined secondary end point, that treating postprandial hyperglycemia may reduce the incidence of new cardiovascular events in people with impaired glucose tolerance (4)—a finding confirmed in type 2 diabetes by a meta-analysis on the use of acarbose (5). Another important issue is that prandial glucose regulation, an emerging approach to treating type 2 diabetes, emphasizes the need for moderating the acute surges in plasma glucose levels that follow meals (6). Mechanistic and epidemiological studies indicate that postprandial glucose significantly contributes to overall glycemic exposure (6). In particular, postprandial hyperglycemia is the most important contributor to A1C, particularly when it is lower than 7.5% (7). Therefore, targeting postprandial hyperglycemia is important for the achievement of A1C targets. Numerous prandial therapeutics are now available, and an ever-growing literature on their use shows …