With the study of the history of medicine, it is fascinating what has risen to the top and what has been discarded as unimportant. As an item of interest, some physicians were convinced that cardiovascular disease is really just a presentation of diabetes mellitus. One such physician, Joseph Kraft, MD, practiced as a pathologist for 35 years in Chicago, Illinois. Dr. Kraft was reported to have performed over 3,000 autopsies during his career. He was convinced that atherosclerosis was due to inflammation in the vascular endothelium. He felt that hyperinsulinemia was the cause of this inflammation. In fact, he developed an insulin assay that suggested that many more patients (than previously suspected by conventional more limited glucose tolerance testing) would be identified to have insulin resistance, an early marker of diabetes mellitus type 2. Dr. Kraft performed over 14,000 insulin assay tests from 1972 to 1988. Dr. Kraft tried to bring this information to the forefront in his book, “Diabetes Epidemic & You.” In a community of clinicians that are seeking to understand ways to improve metabolic health, Dr. Kraft’s research findings MUST be highly relevant. I fear that many of these findings from years past, have been buried and forgotten, especially, if no patentable medication can result from this information. Of course, the main interventions to lower insulin levels are consuming a lower carbohydrate diet, exercising more, and fasting.
As a family physician, I would like my patients to have the best opportunity for health. A recently published journal article gives very useful data in helping my patients understand the risk factors for the #1 cause of death in the U.S., cardiovascular disease (heart disease and stroke). In October 2023, the New England Journal of Medicine (NEJM) published an article titled: Global Effect of modifiable risk factors on cardiovascular disease and mortality. This is a study that includes about 1.5 million patients from 112 cohort studies from 34 countries. The aim of the article is to assess 10-year risk for cardiovascular events and death. Specifically, the article assesses the effects of body mass index, systolic blood pressure, non-HDL-C cholesterol, smoking, and diabetes mellitus on cardiovascular events and death rate. Consistent with Dr. Kraft’s theory, BY FAR, diabetes mellitus, was the most important risk factor cited in the study. In my office practice, I share the results of this study with my patients. Of course, I would love my patients to improve all of these risk factors, but this information helps to target lifestyle change with priority.
Here is the link to the NEJM article abstract: https://www.nejm.org/doi/full/10.1056/NEJMoa2206916.