Primary prevention of cardiovascular disease in pre-diabetes: the glass is half full and half empty

The modern incarnation of the term “pre-diabetes” occurred during a press conference hosted by the Department of Health and Human Services (HHS) and the American Diabetes Association (ADA) on 27 March 2002 to announce the results of the Diabetes Prevention Program (DPP): “ HHS and the ADA are using the new term ‘pre-diabetes’ to describe an increasingly common condition in which blood glucose levels are higher than normal but not yet diabetic—known in medicine as impaired glucose tolerance or impaired fasting glucose. … Most people with this condition go on to develop type 2 diabetes within 10 years. ” Pre-diabetes and type 2 diabetes often cosegregate with hypertension and dyslipidemia (low serum HDL cholesterol and high triglyceride levels) as manifestations of the metabolic syndrome (1), which affects 47 million people in the U.S. (2). Components of the metabolic syndrome can be identified in pre-diabetic subjects several years before the diagnosis of type 2 diabetes. Epidemiological studies, including the Paris Prospective Study (3), have shown that pre-diabetes confers an increased risk of cardiovascular disease (CVD). Patients who progress to type 2 diabetes exhibit additional risk for atherosclerotic disorders, which manifest as a two- to fourfold increase in the prevalence of CVD, stroke, and peripheral vascular diseases, compared with nondiabetic subjects (4). The risk of first myocardial infarction in diabetic patients is similar to that of