Diabetes, hyperglycaemia, hyperinsulinaemia and atherosclerosis: epidemiological data.

Beside arterial hypertension, hypercholesterolaemia and smoking habits, diabetes is considered as a risk factor of coronary heart disease (CHD). However, the role of impaired glucose tolerance (IGT) has not been demonstrated in the different epidemiological studies in the world which are summarized here; hyperinsulinaemia was also suspected and its independent role--investigated in only three prospective surveys--was demonstrated. The recent data of the Paris Prospective Study, where normoglycaemic, IGT and diabetic patients were analysed together, show that hyperinsulinaemia may be the first and genuine marker of the carbohydrate metabolism disturbance connected to the clinical manifestations of atherosclerosis.