This is the fourth of seven reports on the American Diabetes Association (ADA) 60th Scientific Sessions held in San Antonio, TX, in June 2000. It covers topics related to cardiovascular disease (CVD) in diabetes.

CVD Symposium

At a symposium held in conjunction with the meeting, Richard Nesto, Boston, MA, discussed screening for coronary heart disease (CHD) in diabetes. He stressed the importance of early treatment of acute myocardial infarction (MI), noting the increased mortality in the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO) trial with delay in diagnosis (1) and the high prehospitalization mortality in the Finnish Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (FINMONICA) study (2), which suggest the need for screening. This is particularly suggested by recent evidence that intensive risk factor modification improves the prognosis of patients with diabetes and CVD. The patient with diabetes may have either typical or atypical cardiac symptoms. Other patients requiring screening are those with abnormal resting electrocardiogram and those with other evidence of atherosclerosis; peripheral arterial disease, for example, is associated with a fourfold increase in CHD risk. Patients with macroalbuminuria have markedly increased CHD risk as well.

Nesto pointed out that autonomic neuropathy is associated with decreased survival and a high CHD incidence and that this group may respond to treatment with β-blockers in view of their increased sympathetic tone. Cardiac autonomic neuropathy may also result in increased variability in sympathetic activity within the heart, as seen after MI, a potential cause of arrhythmia. Additional indications for CHD screening are the presence of two or more risk factors (dyslipidemia, hypertension, cigarette smoking, or positive family history) and the sedentary patient beginning a vigorous exercise program. The yield of noninvasive testing of patients identified in this fashion is between 10 and 20%.

Nesto described a …