Reduced Coronary Events in Simvastatin-Treated Patients With Coronary Heart Disease and Diabetes or Impaired Fasting Glucose Levels

Abstract

TYPE 2 diabetes mellitus (DM) is associated with at least a 2-fold increased risk of coronary heart disease (CHD).^1-5 In addition, the prognosis of clinical CHD is worse in patients with DM than in nondiabetic patients.^6-8 Although the role of glycemia in CHD in nondiabetic patients is controversial,^9,10 recent evidence¹¹ suggests that glycemia may be significantly related to mortality, even in the nondiabetic range, in a combined analysis of 3 longitudinal cohorts (the Whitehall, Paris Prospective, and Helsinki Policeman studies). In the Framingham Offspring Study,¹² CHD risk that was adjusted for obesity, elevated waist-hip ratio, hypertension, low levels of high-density lipoprotein cholesterol (HDL-C), elevated triglyceride levels, and hyperinsulinemia showed continuous increases across the spectrum of nondiabetic glucose tolerance. Metabolic risk factors for type 2 DM and cardiovascular disease worsened continuously across the spectrum of glucose tolerance categories, beginning in the lowest quintiles of normal fasting glucose (NFG) level.¹²