Asadollahi et al. highlight some important aspects with regard to the cardiovascular mortality associated with hyperglycaemia (JRSM 2007;100:503–7).1 More recently, the cardiovascular morbidity related to hyperglycaemia has become of interest with implications in routine clinical practice. Of late, fasting plasma glucose levels have been demonstrated to independently predict hospitalization for congestive heart failure (CHF) in patients at high cardiovascular risk.2 Of note, glucose levels have also been significantly associated with the risk of developing atrial fibrillation – the most common sustained cardiac arrhythmia.3 Indeed this was also noted in the Framingham study more than a decade ago, when glucose levels were found to be more important than the diagnosis of diabetes mellitus per se.3
The pathophysiology of complications in the setting of hyperglycaemia is multifactorial, and in addition to the classical cardiovascular risk factors such as hypertension, dyslipidaemia and obesity, there are other factors such as urine albumin excretion, endothelial damage/dysfunction and inflammation that develop in parallel, progress with time and eventually contribute towards cardiovascular morbidity.3
Interestingly, if we take into account the results of the national diabetes audit which showed that only a quarter of people with diabetes in the UK have been diagnosed,4 and also consider the large variations in diabetes care,5 this matter becomes all the more pertinent and has substantial implications for the future given the pressing need for strategies to promote and optimize diabetes care from a practical perspective (JRSM 2007;100:67 and JRSM 2006;99:576–81).4,5
Footnotes
Competing Interests All the authors work in the specialty of diabetes and endocrinology and are currently involved in managing patients with hyperglycaemia in routine daily clinical practice.
References
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