Diabetes prevention and cardiovascular complications

  • Silvio E. InzucchiEmail author
  • Catherine M. Viscoli
  • Lawrence H. Young
  • Walter N. Kernan

To the Editor: The review by Nathan et al recently published in Diabetologia provides an excellent discussion of the relationship between diabetes prevention and microvascular and cardiovascular (CV) complications [1]. We agree that the existing data are quite limited, although somewhat more robust for microvascular disease. This is not unexpected, given that hyperglycaemia is more closely aligned with retinopathy and nephropathy than with atherosclerotic CV disease (ASCVD). We noted one important omission, however, from this otherwise complete review. Insulin Resistance Intervention after Stroke (IRIS) was a large, multi-national clinical trial, funded by the US National Institutes of Health, that randomised insulin-resistant (but non-diabetic) individuals with recent stroke or transient ischaemic attack to receive the thiazolidinedione pioglitazone or placebo and assessed the impact on future CV events as well as the diagnosis of diabetes [2].

Pioglitazone is a potent...


Cardiovascular disease Complications Diabetes prevention Impaired fasting glucose Impaired glucose tolerance Pioglitazone Thiazolidinediones 



Actos Now for Prevention of Diabetes


Atherosclerotic cardiovascular disease




Impaired fasting glucose


Impaired glucose tolerance


Insulin Resistance Intervention after Stroke


Myocardial infarction


Relative risk reduction


Contribution statement

All authors were responsible for drafting the article or revising it critically for important intellectual content, and all authors approved the version to be published.

Duality of interest

SEI has served on clinical trial steering or executive committees for Eisai (through the Thrombolysis in Myocardial Infarction [TIMI] Study Group) and AstraZeneca, which have examined diabetes prevention through weight loss or glucose lowering medications. The other authors declare no dualities of interest associated with their contribution to this manuscript.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Silvio E. Inzucchi
    • 1
    Email author
  • Catherine M. Viscoli
    • 2
  • Lawrence H. Young
    • 3
  • Walter N. Kernan
    • 2
  1. 1.Section of Endocrinology/Fitkin 106Yale School of MedicineNew HavenUSA
  2. 2.Section of General MedicineYale School of MedicineNew HavenUSA
  3. 3.Section of Cardiovascular MedicineYale School of MedicineNew HavenUSA

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