Cardiovascular prevention in subjects with impaired fasting glucose or impaired glucose tolerance.

Cardiovascular diseases still represent the leading cause of mortality and hospitalization, particularly in Western countries. As a consequence of the marked changes observed on the demographic characteristics of the general population, the improved survival rate after an acute cardiovascular event, and the progressive rise of costs (mostly due to technological and pharmacological innovations), the estimated burden of cardiovascular diseases will soon become insurmountable for national healthcare systems. In this view, an integrated approach aimed at improving strategies for cardiovascular disease prevention and, thus, limiting the negative outcomes, would probably be successful. Such an approach may not only achieve long-term benefits, but even significant advantages in the short to medium term, mostly in asymptomatic high-risk individuals. Indeed, this latter population of asymptomatic high-risk individuals would mostly benefit from extensive application and improvement of strategies for cardiovascular disease prevention with a favourable cost-benefit ratio. The Italian Society for Cardiovascular Disease Prevention — Società Italiana per la Prevenzione Cardiovascolare (SIPREC) — has recognized this strategic aim, focusing a vast majority of its institutional action on the effort for providing educational supports and consensus documents, which represent an overview of the scientific knowledge and personal clinical expertise by national and international key opinion leaders. Expert committees periodically generate ‘state-of-the-art’ documents on specific scientific topics with relevant socioeconomic implications and large clinical impact. The present article is dedicated to healthcare professionals, and is based on the available evidence, and provides useful information on diagnostic algorithms and therapeutic options. In 2006, the SIPREC Scientific Committee promoted a consensus document on the metabolic syndrome,[1] which is still widely used, frequently cited and updated, from which originated a broad educational programme throughout the Italian territory. This programme has certainly contributed to improving knowledge of a widespread clinical condition, such as the metabolic syndrome, which SIPREC interpreted not only as a theoretical pathophysiological concept or a nosographic entity, but rather as a real clinical tool for identifying and ‘intercepting’ those asymptomatic individuals at risk of cardiovascular events, before the estimated level of risk becomes high. This new article may be viewed in the same strategic line. The relationship between abnormalities in blood glucose metabolism (or dysglycaemia) and cardiovascular complications represents another important and relatively early target for cardiovascular disease prevention. SIPREC Scientific Committee identified even in this clinical setting an excellent group of scientific experts, in order to collect a multidisciplinary ‘task force’. This group has been asked to explain in a short, simple and effective fashion the epidemiological impact and the pathophysiological nature of the problem, its clinical features, potential diagnostic algorithms and therapeutic options, and its influence on the clinical practice of both specialist physicians and general practitioners. The work of this Task Force, which is reported in this article, is primarily a baseline for discussing novel future strategies for cardiovascular prevention. Also, this article is aimed at highlighting the importance of an emerging marker of cardiovascular risk, which is little recognized and often undervalued. Dysglycaemia, in turn, has a clinical significance, which is at least, in part, comparable with that of type 2 diabetes mellitus, both in terms of epidemiological prevalence and of long-term cardiovascular prognosis.