Postprandial hyperglycemia and cardiovascular disease.

OBJECTIVE: To review the role of postprandial hyperglycemia in the development of type 2 diabetes mellitus and cardiovascular disease.

METHODS: The pathogenic mechanisms involved in the deterioration of glucose tolerance are discussed, and findings from relevant epidemiologic and clinical interventional studies are presented.

RESULTS: It is now well established that hyperglycemia is an independent risk factor for cardiovascular disease, with no apparent threshold. In clinical practice, glycemic exposure is measured by hemoglobin A1c levels. These values reflect the contribution of fasting and postprandial plasma glucose levels during the previous 2 to 3 months. Epidemiologic studies have indicated that, at hemoglobin A1c levels (5.5%) already associated with a substantially increased risk for cardiovascular mortality, fasting plasma glucose levels are generally normal. These observations implicate isolated postprandial hyperglycemia as a cardiovascular risk factor. Controlled interventional clinical trials have found that reduction of postprandial hyperglycemia decreases cardiovascular events or surrogates thereof.

CONCLUSION: Postprandial hyperglycemia should be considered a cardiovascular risk factor similar to hypertension, hyperlipidemia, and smoking; accordingly, it should be monitored and treated.