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To The Editor: I disagree with Drs Hackam and Anand¹ that diabetes mellitus is a modifiable risk factor for atherosclerotic vascular disease. None of the 5 prospective studies that have evaluated the effect of lowering glycemia on cardiovascular disease, analyzed either singly² or in a meta-analysis,³ have demonstrated a significant effect. This is probably not surprising, as the association between glycemia and increased cardiovascular disease extends into the mid normal range of glucose values.^4-5

Mayer B. Davidson, MD
Clinical Trials Unit
Charles R. Drew University
Los Angeles, Calif

1. Hackam DG, Anand SS. Emerging risk factors for atherosclerotic vascular disease: a critical review of the evidence. JAMA. 2003;290:932-940. FREE FULL TEXT 2. Wild SH, Dunn CJ, McKeigue PM, Comte S. Glycemic control and cardiovascular disease in type 2 diabetes: a review. Diabetes Metab Res Rev. 1999;15:197-204. FULL TEXT | ISI | PUBMED 3. Huang ES, Meigs JB, Singer DE. The effect of interventions to prevent cardiovascular disease in patients with type 2 diabetes mellitus. Am J Med. 2001;111:633-642. FULL TEXT | ISI | PUBMED 4. Coutinho M, Gerstein HC, Wang Y, Yusuf S. The relationship between glucose and incident cardiovascular events: a metaregression analysis of published data from 20 studies of 95,783 individuals followed for 12.4 years. Diabetes Care. 1999;22:233-240. FREE FULL TEXT 5. Khaw K-T, Wareham N, Luben R, Bingham S, Oakes S, Welch A, Day N. Glycosylated haemoglobin, diabetes, and mortality in men in Norfolk cohort of European Prospective Investigation of Cancer and Nutrition (EPIC-Norfolk). BMJ. 2001;322:15-18. FREE FULL TEXT

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291:301.

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