Development of this book was stimulated by three sobering facts. First, more
than 16 million people in the United States alone are afflicted with diabetes, the
large majority with type 2 diabetes. Second, mortality attributable to cancer, heart
disease unassociated with diabetes, and stroke has declined markedly since 1980,
whereas that associated with diabetes has climbed considerably. Third, coronary
disease is the major cause of death in people with diabetes and, in contrast to
microangiopathy, progression of macrovascular disease is retarded only modestly
by stringent glycemic control. Unfortunately, many still believe that diabetes is
simply hyperglycemia, and advances in understanding the pivotal role of insulin
resistance in type 2 diabetes are often overlooked. If we are to diminish cardiovascular
morbidity and mortality associated with diabetes, we must recognize that,
whether covert or overt, diabetes is tantamount to coronary disease. Without early
and vigilant interventions by physicians, diabetes will continue to spawn acute
coronary syndromes and their enormous toll.