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To the Editor: In their discussion of the relationship between hyperglycemia and atherosclerosis, Dr Beckman and colleagues¹ did not discuss the evidence linking postprandial hyperglycemia to cardiovascular disease. For example, in the Honululu Heart Program,² which followed up more than 6000 men of Japanese ancestry for 12 years, the rate of fatal cardiac disease increased linearly with the degree of postchallenge hyperglycemia. In the Rancho Bernardo cohort,³ cardiovascular mortality more than doubled among women, but not men, with abnormal postprandial hyperglycemia (>200 mg/dL [11.1 mmol/L]) but with normal fasting plasma glucose (<126 mg/dL [7 mmol/L]).³ Moreover, postprandial glucose values, but not fasting plasma glucose or glycohemoglobin levels, were significantly related to increased intima-media thickness of carotid arteries, a marker of atherosclerosis.⁴

Indeed, the significance of postprandial hyperglycemia may extend beyond its relationship to cardiovascular disease. In women with gestational diabetes, adjustment of insulin doses to normalize postprandial rather than preprandial . . . [Full Text of this Article]

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