Cardiovascular Disease and Diabetes
- ACE, angiotensin-converting enzyme
- ARB, angiotensin receptor blocker
- BARI, Bypass Angioplasty Revascularization Investigation
- CABG, coronary artery bypass graft
- CHF, congestive heart failure
- CML, carboxymethyllysine
- CVD, cardiovascular disease
- DCCT, Diabetes Control and Complications Trial
- DECODE, Diabetes Epidemiology: Collaborative analysis Of Diagnostic criteria in Europe
- IFG, impaired fasting glucose
- IGT, impaired glucose tolerance
- IMA, internal mammary artery
- LVH, left ventricular hypertrophy
- MG, methylglyoxal
- NF, nuclear factor
- SU sulfonylurea
- UKPDS, U.K. Prospective Diabetes Study
This is the fourth in a series of articles covering the 2002 American Diabetes Association Annual Meeting, San Francisco, CA, 14–18 June 2002.
Mortality and morbidity in diabetes
Peter Savage (Ellicott City, MD) discussed secular trends in cardiovascular disease (CVD) among patients with diabetes. Two-thirds to three-quarters of patients with diabetes will eventually die of CVD. Diabetes is becoming more important as a cause of CVD in the population because of its increasing prevalence, due to the high incidence in minority populations and the increasing obesity of the population. The “key question,” Savage stated, is whether persons with diabetes are different from those without diabetes in not enjoying the same decline in CVD that has been seen in the overall population over the past 50 years, presumably reflecting a variety of advances in the treatment of risk factors. In a study of time trends in mortality in U.S. adults between surveys in 1971–1975 and in 1982–1984, diabetic men had a decline of 13% in age-adjusted CVD mortality, while that for nondiabetic men was 36%, and diabetic women had an increase of 23%, while women without diabetes had a decline in CVD mortality of 27% (1). Although microvascular disease is relatively specific for diabetes, macrovascular disease appears as an acceleration of the illness seen in persons without diabetes. High LDL is a risk factor in those with and without diabetes, but persons with diabetes tend to have low HDL, high triglyceride, and abnormal LDL particle size. They have the hypertension of the insulin resistance syndrome, which becomes exacerbated with renal disease (and diabetic patients with renal disease have extraordinarily high rates of CVD). Diabetes is associated with coagulation abnormalities and inflammation, as well as hyperglycemia, glycation, and secondary effects on CVD risk factors. Insulin resistance and hyperinsulinemia are additional factors in persons with diabetes.
Savage pointed …
