Do Interventions to Reduce Coronary Heart Disease Reduce the Incidence of Type 2 Diabetes? A Possible Role for Inflammatory Factors

ype 2 diabetes is as a major cause of coronary heart disease (CHD). In some studies, the rate of CHD in type 2 diabetic subjects approaches that observed in some subjects with prevalent CHD. 1 Additionally, the case fatality rate of CHD is increased in type 2 diabetics. In one Finnish study, 50% of diabetic men who had a first coronary heart event died within a year of their initial presentation; 50% of these fatal cases died before they reached the hospital ("sudden death"). These subjects, by definition, could not benefit from a secondary prevention program. 2 Clearly, preventing type 2 diabetes would be important in the reduction of CHD. The Diabetes Prevention Program 3 is a large National Institutes of Health-funded trial to prevent diabetes in subjects with impaired glucose tolerance. The interventions being tested are metformin and intensive lifestyle changes. Recently, the Finnish Diabetes Prevention Program reported a 58% reduction in the incidence of type 2 diabetes in 523 subjects with impaired glucose tolerance (American Diabetes Association, personal communication, June 2000).