• sugar
• insulin
• coronary heart disease

‘I know of no single acceptable study that shows a high intake of sugar in a population that is almost entirely free from heart disease.’1—John Yudkin

Coronary heart disease (CHD) is responsible for one in every six deaths in the USA,2 and it eventually manifests as an acute myocardial infarction (MI). In the USA, almost 1 million acute MIs occur each year2 with approximately 15% of patients dying as a result of their acute event.2 If one manages to survive an acute MI, depending on the age of onset, the average survival time ranges anywhere from just 3.2 years to up to 17 years.2 Thus, CHD and acute MI are leading causes of early mortality in the USA.2

Asymptomatic hyperglycaemia is a risk factor for cardiovascular disease (CVD) and CHD, as well as death from CHD.3 Hyperglycaemia can develop during an acute MI, even in patients without diabetes,3 which may be caused by an increase in catecholamines, a reduction in the release of insulin, development of insulin resistance and increases in cortisol and growth hormone.3–5 However, many patients with MI already have diabetes and simply have yet to be diagnosed (ie, latent diabetes), where the acute stress worsens their diabetic state leading to hyperglycaemia.3 Indeed, one study showed that 73% of patients presenting with an acute MI have abnormal glucose tolerance, with 50% having diabetes.6 After 6 months, 43% still had abnormal glucose tolerance, which is approximately threefold higher than that found in matched controls (15%), the difference between the two being significant.6 Thus, hyperglycaemia does not seem to be an acute or temporary finding in patients who have experienced an MI, with many of these patients having continued abnormal glucose tolerance even when followed for several years after their event.

The …