142 Diabetes Spectrum Volume 26, Number 3, 2013 Preface Thomas E. Kottke, MD, MSPH, Guest Editor Four Opportunities to Prevent Diabetes and Coronary Heart Disease Starting with the North Karelia Project in Finland, continuing with the large community-based heart dis- ease prevention trials in the United States, 1,2 and organizing CardioVision 2020 in Olmsted County, Minnesota, 3 I have been involved with heart dis- ease prevention programs for 40 years. During that time period, the preva- lence of type 2 diabetes in the United States increased by one-third, and it is predicted to increase even more. 4 Because the disease more than doubles the risk of death from heart disease 5 and now contributes signifcant pop- ulation-attributable risk, I am excited to have added my perspective, and perhaps contributed to the control of diabetes, by accepting the role of guest editor of this Diabetes Spectrum From Research to Practice section. Randomized, clinical trials are prima facie evidence that type 2 diabetes can be prevented. I clearly remember a day in Helsinki more than 10 years ago, when I was teach- ing at the World Health Organization noncommunicable disease prevention seminar. Jaakko Tuomilehto, MD, PhD, the principal investigator of the Finnish Diabetes Prevention Trial took me aside and told me that their results would be coming out in the New England Journal of Medicine. The publication of this landmark study 6 was followed about a year later by the report of the larger, American Diabetes Prevention Program. 7 The fndings of the two trials were nearly identical: lifestyles that comprise a diet that is low in saturated fat, include adequate physical activity, and lead to modest weight loss can prevent diabetes in high-risk individuals. Unfortunately, the scientific com- munity has yet to be able to translate these fndings to achieve diabetes con- trol at a population level. The extent to which clinicians ought to focus on weight and weight loss also remains unclear. Earlier this year, Flegal et al. 8 published a system- atic review and meta-analysis of the association between all-cause mor- tality and standard BMI categories. Perhaps surprisingly, grade 1 obe- sity (BMI 30.0–34.9 kg/m 2 ) was not associated with higher mortality, and overweight was associated with sig- nificantly lower all-cause mortality than an “ideal” BMI. Perhaps even more surprising is the phenomenon of the “obesity paradox,” the survival advantage of overweight and obese patients with type 2 dia- betes. Therefore, I asked Marion J. Franz, MS, RD, CDE, to help readers understand the obesity paradox and diabetes (p. 145). Citing the American Diabetes Association position that “a goal of medical therapy for individuals with diabetes is to achieve and main- tain blood glucose levels in the normal range or as close to normal as is safely possible, a lipid and lipoprotein profle that reduces the risk for vascular dis- ease, and blood pressure levels in the normal range or as close to normal as safely possible,” 9 her article offers concise, evidence-informed advice that clinicians should prescribe nutrition interventions that optimize metabolic parameters, include lifestyle changes that patients are willing and able to make, and focus on appropriate por- tion sizes of foods shown to have health benefts. Given our inability to prevent every case of diabetes, prevention of disease complications with compounds such as aspirin remains important. Aspirin was developed as an analgesic in the 19th century, and its properties