Why does diabetes cause chd

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Relationship between urinary albumin excretion and left ventricular mass with mortality in patients with type 2 diabetes. Clin J Am Soc Nephrol. Collaborative overview of randomised trials of antiplatelet therapy-II: Maintenance of vascular graft or arterial patency by antiplatelet therapy. Amplified benefit of clopidogrel versus aspirin in patients with diabetes mellitus. Am J Cardio. You can use it when you meet with your health care team in person or remotely. Talk with your team about your goals and how you are doing, and whether you need to make any changes to your diabetes care plan.

Healthy lifestyle habits that you stick with can help you manage your diabetes and prevent heart disease. Learn more about these tips to manage diabetes. Watch a video about what you can do to keep your heart healthy. Learn about the Body Weight Planner , which may help you create a personal plan to reach your goal weight. Managing diabetes is not always easy. Feeling stressed, sad, lonely, or angry is common when you are living with diabetes.

You may know what to do to stay healthy but may have trouble sticking with your plan over time. Long-term stress can raise your blood glucose and blood pressure, but you can learn ways to lower your stress. Try deep breathing, gardening, taking a walk, doing yoga, talking with a loved one, working on a hobby, or listening to your favorite music.

Learn more about healthy ways to cope with stress. Medicines may be an important part of your treatment plan. Your doctor will prescribe medicine based on your specific needs. Medicine may help you. Ask your doctor whether you should take daily aspirin. Aspirin is not safe for everyone. Your doctor can tell you whether taking aspirin is right for you and exactly how much to take. Statins can reduce the risk of having a heart attack or stroke in some people with diabetes.

In addition, certain diabetes medicines have been shown to reduce the risk of heart attacks and death in patients at very high risk of having a heart attack. Talk with your doctor to find out whether taking a statin or a diabetes medicine that reduces heart attack risk is right for you.

Take medicines the way your doctor or health care team tells you to. Talk with your doctor or pharmacist if you have questions about your medicines. Before you start a new medicine, ask your doctor about possible side effects and how you can avoid them. If the side effects of your medicine bother you, tell your doctor. Doctors diagnose heart disease in people with diabetes based on their. Tests used to monitor your diabetes—A1C, blood pressure, and cholesterol—help your doctor decide whether it is important to do additional tests to check your heart health or to refer you to a specialist such as a cardiologist.

Treatment works best when it is given right away. Warning signs can be different in different people. You may not have all the listed symptoms. The report explained that a more intensive prevention strategy is justified in diabetic patients because of their high risk of new CAD within 10 years, and because of the high death rate observed in diabetics who experience a MI [ 35 ]. In the following section we will briefly highlight and discuss the evidence behind these 2 observations.

Diabetic patients have twice the risk of myocardial infarction MI and stroke of that of the general population [ 36 ]. In their cross-sectional study, Haffner et al. During a seven-year followup and after adjustment for other cardiovascular risk factors, the risk of myocardial infarction and the mortality from coronary heart disease were similar in diabetics without prior myocardial infarction and nondiabetics with prior myocardial infarction [ 37 ].

This observation, derived from a group of middle-aged and older individuals, has been integrated into clinical practice and served as a premise to consider diabetes a CVD equivalent.

Nonetheless, age remains an important factor to take into account when assessing the risk of diabetic patients. In a large population-based retrospective cohort study, Booth et al. However, younger diabetics age 40 or younger do not appear to be at high risk of CVD [ 38 ].

Diabetic patients are also known to have worse outcomes after an acute coronary syndrome when compared with the general population. Insulin treated patients had the worse outcomes in both trials and diabetes carried a higher adverse impact in women compared to men in the GISSI-2 trial.

Data from a meta-analysis of 19 trials comparing primary PCI and fibrinolysis in ST elevation MI showed that diabetic patients had a higher mortality reduction with PCI but continued to have worse outcomes than nondiabetics [ 45 ].

OASIS showed one more time a more ominous impact of diabetes on female patients compared to their male counterparts. In addition to the higher incidence of clinically significant cardiovascular events, type 2 diabetes is also associated with a higher rate of subclinical CAD. Non-hemodynamically significant coronary lesions can remain latent before resulting in myocardial ischemia.

More importantly diabetic autonomic neuropathy can impair ischemia awareness and has been associated with an increased risk of cardiovascular mortality [ 47 ]. Noninvasive computed tomography using coronary artery calcium CAC scoring or angiography is now capable of detecting asymptomatic CAD even before the onset of silent ischemic electrocardiographic changes and coronary perfusion defects during stress testing.

In a prospective study of asymptomatic patients with uncomplicated type 2 diabetes, significant CAC a reliable marker of atherosclerosis was seen in The extent of CAC was a strong predictor of silent ischemia by radionuclide myocardial perfusion imaging and short-term cardiovascular events [ 48 ]. The DIAD trial randomized asymptomatic type 2 diabetics to adenosine stress radionuclide myocardial perfusion imaging or no screening.

A retrospective observational study of asymptomatic patients with type 2 diabetes showed that stratifying the patients according to the number of additional CVD risk factors they have did not affect their likelihood of having an abnormal myocardial perfusion test and significant coronary artery disease.

However patients with 2 or more additional risk factors had a higher likelihood of having more severe CAD with unfavorable angiographic anatomy not amenable to complete percutaneous or surgical revascularization [ 50 ].

Based on the above findings, clinicians might feel compelled to screen asymptomatic diabetics in an attempt to detect early stages of CAD and implement appropriate therapies. Such an enthusiasm should be tempered by the fact that intensive medical therapy is indicated for all diabetic patients at high risk for CVD which makes screening results unlikely to change management. In addition diagnostic testing can be expensive and can potentially lead to unnecessary procedures and complications.

Furthermore the hypothesis that asymptomatic diabetic patients benefit from revascularization remains unproven. There was no significant difference in death or serious adverse cardiovascular events between both groups [ 51 ].

Additional data supporting the futility of screening asymptomatic patients came from the DIAD trial where no significant difference in cardiac death or nonfatal MI was seen between the screening and no-screening groups at a mean followup of 4. Major society guidelines have made the following recommendations about screening for asymptomatic CAD in diabetic patients. The guidelines recommend exercise testing if an individual meeting the above criteria is planning to begin a moderate- to high-intensity exercise class IIa; level of evidence: C [ 53 ].

The authors acknowledge that there is no evidence supporting that this imaging test is useful in motivating patients to better adhere to primary prevention measures. The same guidelines give a weak class IIb level of evidence: C recommendation to consider stress MPI for advanced cardiovascular risk assessment in asymptomatic adults with diabetes or in patients who have a CAC score of or greater [ 54 ]. The guidelines acknowledge that newer noninvasive CT modalities can identify asymptomatic diabetic patients with a higher CAD burden and a higher risk of future cardiac events.

However they consider that the role of these tests beyond risk stratification is unclear with a controversial balance of benefit, cost, and risks [ 55 ]. The number of people with diabetes is increasing due to population growth, aging, urbanization, and increasing prevalence of obesity and physical inactivity [ 16 , 56 , 57 ].

Quantifying the prevalence of diabetes and the number of people affected by diabetes, now and in the future, is important to allow rational planning and allocation of resources. The prevalence of diabetes for all age-groups worldwide was found to be 2.

The total number of people with diabetes is projected to rise from million in , to million in to million in [ 58 ]. The prevalence of diabetes is higher in men than women, but there are more women with diabetes than men. The urban population in developing countries is projected to double between and The public health epidemic of diabetes will certainly affect the growth of these emerging economies.

As the prevalence of diabetes increases so will the need for healthcare services primary, secondary, and tertiary in these developing countries. Unfortunately, data about the use of effective secondary prevention medications in patients with known cardiovascular disease reflects the importance of this challenge. The Prospective Urban Rural Epidemiological PURE study which enrolled between and patients with cardiovascular disease from 17 countries with variable levels of income showed that the use of appropriate drugs antiplatelet drugs, ACE inhibitors or ARBs, or statins was universally low and decreased in line with reduction of country economic level.

The percentage of patients receiving no drugs was Moreover access to cardiac revascularization including cardiac surgery and catheter-based techniques remains disproportionate in different parts of the world even within Europe and North America [ 60 ].

This has led major scientific societies to develop appropriateness and necessity criteria that can guide decision-making and identify the overuse and underuse of revascularization procedures. Historically, coronary artery bypass grafting CABG is the established method of revascularization in patients with diabetes and multivessel coronary disease, but with advances in percutaneous coronary intervention PCI , there is uncertainty whether CABG remains the preferred method of revascularization.

Kapur et al. The primary outcome was a composite of all-cause mortality, myocardial infarction MI , and stroke, and the main secondary outcome included the addition of repeat revascularization to the primary outcome events. At 1 year of followup, the composite rate of death, MI, and stroke was Regardless of the revascularization approach PCI versus CABG , the overall increase in prevalence will lead to an increased demand of tertiary services for patients who suffer from diabetes and its most fatal complication cardiovascular disease.

The result will be an increased burden on the emerging economies of these developing countries. Diabetes mellitus is associated with an increased risk of cardiovascular death and a higher incidence of cardiovascular diseases including coronary artery disease. The substantial rise in prevalence of diabetes will ultimately lead to a huge increase in the demand for primary, secondary, and tertiary healthcare services globally.

The need for appropriate screening and cardiac testing is crucial to help better manage the end result cardiovascular disease of this global epidemic. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Article of the Year Award: Outstanding research contributions of , as selected by our Chief Editors.

Read the winning articles. Journal overview. Special Issues. Academic Editor: Eoin O'Brien. Received 22 Jun Accepted 08 Sep Published 18 Oct Abstract Cardiovascular disease remains a leading cause of death in the United States and the world.

Prevalence of Cardiac Disease among Diabetics Diabetes mellitus has been well described as a cardiovascular risk factor in developed countries. Diabetes in the Developing Countries Our current knowledge about the epidemiology of diabetes mellitus and its association with cardiovascular disease is mainly derived from studies done in populations of European origin. Pathogenesis of CAD in Diabetes There is a consensus in the literature about an increased prevalence of coronary plaques in diabetic hearts, with such plaques bearing a higher propensity for rupture.

Hypertension in Diabetes Hypertension is often found at the time of diagnosis of type 2 diabetes even in the absence of microalbuminuria [ 26 ]. Diabetes as a Cardiovascular Disease CVD Equivalent and a Poor Prognostic Factor in Acute Coronary Syndromes Most guideline documents recommend treating cardiovascular risk factors in diabetic patients as aggressively as in patients with established coronary artery disease. Cardiac Testing in Asymptomatic Patients with Diabetes Mellitus In addition to the higher incidence of clinically significant cardiovascular events, type 2 diabetes is also associated with a higher rate of subclinical CAD.

Epidemiologic Consequences of Diabetes and Heart Disease on a Global Scale The number of people with diabetes is increasing due to population growth, aging, urbanization, and increasing prevalence of obesity and physical inactivity [ 16 , 56 , 57 ].

Conclusion Diabetes mellitus is associated with an increased risk of cardiovascular death and a higher incidence of cardiovascular diseases including coronary artery disease. References T. Rosamond, K. Flegal, G. Page last reviewed: 10 March Next review due: 10 March Your risk of developing atherosclerosis is significantly increased if you: smoke have high blood pressure hypertension have high cholesterol have high levels of lipoprotein a do not exercise regularly have diabetes Other risk factors for developing atherosclerosis include: being obese or overweight having a family history of CHD — the risk is increased if you have a male relative under the age of 55, or a female relative under 65, with CHD Smoking Smoking is a major risk factor for coronary heart disease.

High blood pressure High blood pressure hypertension puts a strain on your heart and can lead to CHD. Read more about high blood pressure. High cholesterol Cholesterol is a fat made by the liver from the saturated fat in your diet.

Read more about high cholesterol. High lipoprotein a Like cholesterol, lipoprotein a , also known as LP a , is a type of fat made by the liver. Lack of regular exercise If you're inactive, fatty deposits can build up in your arteries.