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Diabetes And Coronary Artery Disease

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Type 2 Diabetes And Cardiovascular Disease In Women

Type 2 Diabetes And Cardiovascular Disease In Women

Abstract Cardiovascular disease is the leading cause of death in both men and women. This is also true for patients with diabetes. In general, differences between the sexes are present in several areas, such as epidemiology, pathophysiology, diagnostics, treatment response and prognosis, as well as the way in which disease is experienced and expressed. Cardiovascular disease presents later in life in women, who are therefore more likely to suffer from comorbidities. However, this age-related difference is attenuated in women with diabetes, who suffer their first myocardial infarction at about the same age as men with diabetes. Diabetes mellitus increases the risk of cardiovascular disease by three to four times in women and two to three times in men, after adjusting for other risk factors. This paper describes the differences in cardiovascular disease in men and women and the special situation of women with type 2 diabetes when it comes to risk factors, symptoms and the setting of acute coronary syndromes. Furthermore, it highlights the importance of sex-specific analyses in clinical research to improve our knowledge of cardiovascular disease in women in general and in women with diabetes in particular. The importance of taking sex into account when treating women and men at risk of cardiovascular disease is discussed. Notes The authors declare that there is no duality of interest associated with this manuscript. Both the authors have received speaking honoraria from pharmaceutical companies. Both authors were responsible for the conception, design and drafting of the manuscript, and approved the final version for publication. Continue reading >>

Is Diabetes Really A Chd Risk Equivalent?

Is Diabetes Really A Chd Risk Equivalent?

There is little doubt that in the realm of cardiovascular disease, diabetes mellitus (DM) is one of the most important risk factors. From 1980 through 2014, the number of US adults with diabetes has nearly quadrupled from 5.5 million to 21.9 million.1 This remarkable statistic serves as a somber reminder that efforts to prevent DM as well as its impact on cardiovascular disease remains of utmost importance. Almost 18 years ago, Haffner et al.2 reported that adults with DM had the same risk for future myocardial infarction (MI) as adults with previous MI and without DM. Consequently, the National Cholesterol Education Program (NECP) Adult Treatment Panel (ATP) III guidelines in 2001 recommended that all individuals with DM be considered as "coronary heart disease risk equivalent."3 The assertion that all patients with DM are coronary heart disease equivalent has been controversial since the publication of a systematic review and meta-analyses in 2009.4 This matter remained unresolved, as it was pointed out that studies included in that analyses were relatively small and most of the studies comprised cohorts from the 1990s. Some later studies had been limited to a single gender5,6 while others lacked the ability to adjust for important confounding risk factors7,8 and only a few studies have been able to evaluate the impact of the duration of diabetes.5,9,10 There was also a paucity of data among relatively young (30-40 years) patients with DM. For all these reasons, updated evidence from a contemporary population was needed to inform our understanding of coronary heart disease risk in DM patients. A recent study from Kaiser Permanente Northern California (KPNC), a large integrated health care delivery system, compared the risk of a coronary heart disease event among indiv Continue reading >>

Diabetes And Your Heart

Diabetes And Your Heart

If you have diabetes, you are more likely to develop coronary heart disease than someone without diabetes. Diabetes causes high levels of glucose in your blood. This is because of a problem with a hormone your pancreas produces called insulin. Insulin is responsible for moving glucose (a type of sugar) from your bloodstream and into the cells of your body for energy. If there little or no insulin being produced, or your body has become resistant to insulin, glucose stays in the bloodstream and can’t move across to your cells to give them energy to work properly. High levels of glucose in your blood can damage the walls of your arteries, and make them more likely to develop fatty deposits (atheroma). If atheroma builds up in your coronary arteries (the arteries that supply oxygen-rich blood to your heart) you will develop coronary heart disease, which can cause angina and heart attack. Types of diabetes Type one diabetes happens when your body cannot make insulin. This type most commonly affects children and young adults, and is a result of your body’s immune system attacking the cells that produce insulin in the pancreas. Type two diabetes occurs when your pancreas isn’t producing enough insulin or your body has become resistant to the insulin it’s producing. Type two diabetes is much more common than type 1 and tends to develop gradually as people get older – usually after the age of 40, but more and more people every year are being diagnosed at a much younger age. It's closely linked with: being overweight, especially if you carry weight around your middle being physically inactive a family history of type 2 diabetes. Some ethnic groups have a much higher rate of diabetes - particularly people of South Asian and African Caribbean origin. Diabetes and your he Continue reading >>

The Connection Between Diabetes, Heart Disease, And Stroke

The Connection Between Diabetes, Heart Disease, And Stroke

Aaron contacted TheDiabetesCouncil with some questions related to diabetes and heart disease. Aaron is 57 years old. He has had Type 2 diabetes for 12 years. Aaron visited his doctor related to swelling in his ankles and feet, shortness of breath, and weight gain. After some tests, the doctor informed him that on top of his Type 2 diabetes, he now has congestive heart failure. He was now wondering why did he have heart disease now and was it because of his diabetes? In order to help Aaron and other people with diabetes understand the connection between diabetes and heart disease and how to prevent it, we decided to look into the specific link between the two diseases. What is the connection between diabetes and heart disease? According to the American Heart Association, there exist a relationship between cardiovascular disease and diabetes: 68% percent of people with diabetes who are aged 65 and older die from heart disease and 16% die of a stroke. People with diabetes are more likely to die from a heart disease than those without diabetes. The National Institute of Health states the following for people with diabetes: They have additional causes of heart disease They are at higher risk of heart disease than those who do not have diabetes They may develop heart disease at a younger age Risk assessment must take into account the major risk factors (cigarette smoking, elevated blood pressure, abnormal serum lipids and lipoproteins, and hyperglycemia) and predisposing risk factors (excess body weight and abdominal obesity, physical inactivity, and family history of CVD). Identification of risk factors is a major first step for developing a plan for risk reduction in persons with diabetes. – Scott M. Grundy et al, Diabetes and Cardiovascular Disease In two words, the conn Continue reading >>

Diabetes As Coronary Artery Disease Risk Equivalent: Ahistorical Perspective Hajar R - Heart Views

Diabetes As Coronary Artery Disease Risk Equivalent: Ahistorical Perspective Hajar R - Heart Views

Diabetes mellitus(DM) is a cardiovascular disease. [1] It may be inappropriate to make such statement because traditionally, diabetes is a disease in the realm of internal medicine. However, coronary heart disease(CHD), stroke, peripheral arterial disease, nephropathy, retinopathy, and possibly even neuropathy and cardiomyopathy are the complications of diabetes. Therefore, we can safely claim that the cardiac complications of diabetes make this disease a major risk factor in the causation of CHD. The Framingham study demonstrated that the presence of diabetes increased the risk of clinical atherosclerotic disease from twofold to threefold,with coronary artery disease(CAD) as its chief sequelae. Morbidity and mortality were higher for diabetic women. After adjustment for other associated risk factors, cardiovascular mortality was increased for both diabetic women and men. [2] The prevalence of diabetes is increasing worldwide, especially in developed countries(USA and Europe) because of aging of the population and an increasing prevalence of obesity and sedentary life habits. The WHO Global report on diabetes [2] issued the following statistics:(1) the global prevalence of diabetes among adults over18years of age has risen from 4.7% in 1980 to 8.5% in 2014;(2) the number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014;(3) diabetes is a major cause of blindness, kidney failure, heart attacks, stroke, and lower limb amputation;(4) almost half of all deaths attributable to high blood glucose occur before the age of 70years;(5) in 2012, an estimated 1.5 million deaths were directly caused by diabetes and another 2.2 million deaths were attributable to high blood glucose;(6) diabetes prevalence has been rising more rapidly in middle-and low Continue reading >>

Diabetes And Cardiovascular Disease

Diabetes And Cardiovascular Disease

This statement examines the cardiovascular complications of diabetes mellitus and considers opportunities for their prevention. These complications include coronary heart disease (CHD), stroke, peripheral arterial disease, nephropathy, retinopathy, and possibly neuropathy and cardiomyopathy. Because of the aging of the population and an increasing prevalence of obesity and sedentary life habits in the United States, the prevalence of diabetes is increasing. Thus, diabetes must take its place alongside the other major risk factors as important causes of cardiovascular disease (CVD). In fact, from the point of view of cardiovascular medicine, it may be appropriate to say, “diabetes is a cardiovascular disease.” Clinical Presentations of Diabetes Mellitus The most prevalent form of diabetes mellitus is type 2 diabetes. This disorder typically makes its appearance later in life. The underlying metabolic causes of type 2 diabetes are the combination of impairment in insulin-mediated glucose disposal (insulin resistance) and defective secretion of insulin by pancreatic β-cells. Insulin resistance develops from obesity and physical inactivity, acting on a substrate of genetic susceptibility.1 2 Insulin secretion declines with advancing age,3 4 and this decline may be accelerated by genetic factors.5 6 Insulin resistance typically precedes the onset of type 2 diabetes and is commonly accompanied by other cardiovascular risk factors: dyslipidemia, hypertension, and prothrombotic factors.7 8 The common clustering of these risk factors in a single individual has been called the metabolic syndrome. Many patients with the metabolic syndrome manifest impaired fasting glucose (IFG)9 even when they do not have overt diabetes mellitus.10 The metabolic syndrome commonly precedes the Continue reading >>

Diabetes, Heart Disease, And Stroke

Diabetes, Heart Disease, And Stroke

Having diabetes means that you are more likely to develop heart disease and have a greater chance of a heart attack or a stroke. People with diabetes are also more likely to have certain conditions, or risk factors, that increase the chances of having heart disease or stroke, such as high blood pressure or high cholesterol. If you have diabetes, you can protect your heart and health by managing your blood glucose, also called blood sugar, as well as your blood pressure and cholesterol. If you smoke, get help to stop. What is the link between diabetes, heart disease, and stroke? Over time, high blood glucose from diabetes can damage your blood vessels and the nerves that control your heart and blood vessels. The longer you have diabetes, the higher the chances that you will develop heart disease.1 People with diabetes tend to develop heart disease at a younger age than people without diabetes. In adults with diabetes, the most common causes of death are heart disease and stroke. Adults with diabetes are nearly twice as likely to die from heart disease or stroke as people without diabetes.2 The good news is that the steps you take to manage your diabetes also help to lower your chances of having heart disease or stroke. What else increases my chances of heart disease or stroke if I have diabetes? If you have diabetes, other factors add to your chances of developing heart disease or having a stroke. Smoking Smoking raises your risk of developing heart disease. If you have diabetes, it is important to stop smoking because both smoking and diabetes narrow blood vessels. Smoking also increases your chances of developing other long-term problems such as lung disease. Smoking also can damage the blood vessels in your legs and increase the risk of lower leg infections, ulcers, a Continue reading >>

Heart Disease: The Diabetes Connection

Heart Disease: The Diabetes Connection

Most people living with diabetes are aware that they have an increased risk of cardiovascular disease. But the statistics can be truly staggering: Nearly two-thirds of people with diabetes have high blood pressure, and, according to the American Diabetes Association, people with diabetes are two to four times more likely to die of heart disease or have a stroke than people who don't have the condition. The good news: Learning more about the link between heart disease and diabetes can help you take steps to help protect your heart and manage your diabetes. How Diabetes and Heart Disease Are Related The connection between diabetes and heart disease starts with high blood sugar levels. Over time, the high glucose in the bloodstream can damage the arteries, causing them to become stiff and hard. Fatty material that builds up on the inside of these blood vessels, a condition known as atherosclerosis. This can eventually block blood flow to the heart or brain, leading to heart attack or stroke. Your risk of heart disease with diabetes is further elevated if you also have a family history of cardiovascular disease or stroke. Other heart facts to consider: People with diabetes develop cardiovascular disease at a much earlier age than others. Heart disease that leads to heart attack or stroke is the leading cause of death among people with diabetes. A person who has diabetes has the same risk of heart attack as someone who is not diabetic, but already had a heart attack. Protecting Your Heart When You Have Diabetes If you believe you are at a higher risk for heart disease, don’t despair. There are several small lifestyle changes you can make to not only help prevent heart disease, but also manage your diabetes more effectively. Be active. The American Heart Association recomme Continue reading >>

Coronary Artery Disease And Diabetes Mellitus

Coronary Artery Disease And Diabetes Mellitus

Coronary artery disease and diabetes mellitus Doron Aronson , MD* and Elazer R. Edelman , MD, PhD *Department of Cardiology, Rambam Medical Center and the Rappaport Research Institute, Technion, Israel Institute of Technology, Haifa, Israel Institute for Medical Science and Engineering, Massachusetts Institute of Technology, and Cardiovascular Division, Department of Medicine, Brigham and Womens Hospital, Harvard Medical School *Department of Cardiology, Rambam Medical Center and the Rappaport Research Institute, Technion, Israel Institute of Technology, Haifa, Israel Institute for Medical Science and Engineering, Massachusetts Institute of Technology, and Cardiovascular Division, Department of Medicine, Brigham and Womens Hospital, Harvard Medical School The publisher's final edited version of this article is available at Cardiol Clin This article has been republished " Coronary Artery Disease and Diabetes Mellitus. " in Heart Fail Clin, volume 12 onpage117. See other articles in PMC that cite the published article. Coronary artery disease (CAD) is a major determinant of the long-term prognosis among patients with diabetes mellitus (DM). DM is associated with a 2 to 4-fold increased mortality risk from heart disease. Furthermore, in patients with DM there is an increased mortality after MI, and worse overall prognosis with CAD. Near-normal glycemic control for a median of 3.5 to 5 years does not reduce cardiovascular events. Thus, the general goal of HbA1c <7% appears reasonable for the majority of patients. Iatrogenic hypoglycemia is the limiting factor in the glycemic management of diabetes, and is an independent cause of excess morbidity and mortality. Statins are effective in reducing major coronary events, stroke, and the need for coronary revascularization. Sele Continue reading >>

Diabetes & Coronary Heart Disease: Current Perspectives

Diabetes & Coronary Heart Disease: Current Perspectives

Diabetes & coronary heart disease: Current perspectives We are experimenting with display styles that make it easier to read articles in PMC. The ePub format uses eBook readers, which have several "ease of reading" features already built in. The ePub format is best viewed in the iBooks reader. You may notice problems with the display of certain parts of an article in other eReaders. Generating an ePub file may take a long time, please be patient. Diabetes & coronary heart disease: Current perspectives Mohammed K. Ali, K.M. Venkat Narayan, and Nikhil Tandon Coronary heart disease (CHD) is currently the leading cause of death worldwide and together with diabetes, poses a serious health threat, particularly in the Indian Asian population. Risk factor management has evolved considerably with the continued emergence of new and thought-provoking evidence. The stream of laboratory- and population-based research findings as well as unresolved controversies may pose dilemmas and conflicting impulses in most clinicians, and even in our more well-informed patients. As results of the most recent clinical trials on glycaemic control for macrovascular risk reduction are woven into concrete clinical practice guidelines, this paper seeks to sort through unwieldy evidence, keeping these findings in perspective, to deliver a clearer message for the context of South Asia and cardio-metabolic risk management. Keywords: Coronary heart disease, diabetes, glycaemic control, hypertension, lipid, risk factors Cardiovascular diseases (CVD), comprising coronary heart (CHD) and cerebro-vascular diseases, are currently the leading cause of death globally, accounting for 21.9 per cent of total deaths, and are projected to increase to 26.3 per cent by 2030 1 . The factors that coalesce to increase t Continue reading >>

The Pathophysiology Of Cardiovascular Disease And Diabetes: Beyond Blood Pressure And Lipids

The Pathophysiology Of Cardiovascular Disease And Diabetes: Beyond Blood Pressure And Lipids

In Brief The pathophysiology of the link between diabetes and cardiovascular disease (CVD) is complex and multifactorial. Understanding these profound mechanisms of disease can help clinicians identify and treat CVD in patients with diabetes, as well as help patients prevent these potentially devastating complications. This article reviews the biological basis of the link between diabetes and CVD, from defects in the vasculature to the cellular and molecular mechanisms specific to insulin-resistant states and hyperglycemia. It concludes with a discussion of heart failure in diabetes, a clinical entity that demonstrates many of the mechanisms discussed. Diabetes is a prime risk factor for cardiovascular disease (CVD). Vascular disorders include retinopathy and nephropathy, peripheral vascular disease (PVD), stroke, and coronary artery disease (CAD). Diabetes also affects the heart muscle, causing both systolic and diastolic heart failure. The etiology of this excess cardiovascular morbidity and mortality is not completely clear. Evidence suggests that although hyperglycemia, the hallmark of diabetes, contributes to myocardial damage after ischemic events, it is clearly not the only factor, because both pre-diabetes and the presence of the metabolic syndrome, even in normoglycemic patients, increase the risk of most types of CVD.1–4 In 2002, a survey of people in the United States with diagnosed diabetes found that, surprisingly, 68% of patients did not consider themselves at risk for heart attack or stroke.5 In addition, only about half of patients surveyed reported that their health care providers discussed the high risk of CVD in diabetes and what steps they could take to reduce that risk.5 Fortunately, we are now making the link. Health care providers are now focuse Continue reading >>

Coronary Artery Disease And Diabetes Mellitus - Sciencedirect

Coronary Artery Disease And Diabetes Mellitus - Sciencedirect

Volume 11, Issue 4 , August 2016, Pages 330-338 Coronary artery disease and diabetes mellitus Author links open overlay panel Mansour M.Al-NozhaFACCa Diabetes mellitus (DM) and coronary artery disease (CAD) are closely related. DM is a risk factor for CAD, but it is also equivalent to established CAD. The prevalence of DM and CAD is growing primarily due to the rising prevalence of obesity. The rapidly changing life style, especially in developing countries, plays major role in the occurrence of these diseases. We performed a literature review to summarize and explore the relationship between CAD and DM with a special focus on Arab countries in terms of risk factors and prevalence. We suggest future directions to prevent escalation in the incidence of DM and CAD in Arab countries. An important part of any preventive program for CAD should include clear prevention strategies for DM and other associated metabolic risk factors, such as obesity. Preventive measures, such as physical exercise in high-risk groups, at the population level should be encouraged. Continue reading >>

Coronary Artery Disease In People With Diabetes: Diagnostic And Risk Factor Evaluation

Coronary Artery Disease In People With Diabetes: Diagnostic And Risk Factor Evaluation

CLINICAL DIABETES VOL. 17 NO. 2 1999 These pages are best viewed with Netscape version 3.0 or higher or Internet Explorer version 3.0 or higher. When viewed with other browsers, some characters or attributes may not be rendered correctly. FEATURE ARTICLE James H. Caldwell, MD IN BRIEF People with diabetes are at high risk from coronary artery disease (CAD), tend to present late, and have silent ischemia. Early detection and intervention may improve survival. How to identify these patients is the topic of this review, which will discuss cardiac stress testing in diabetic patients with and without known CAD. The authors discuss who should be tested and review the modalities available for detection of CAD and for risk stratification. CORONARY ARTERY DISEASE AND DIABETES Cardiovascular disease is the leading cause of death among people with type 1 and type 2 diabetes. Coronary artery disease (CAD) is the cause of death in more than half of all diabetic patients, and many are debilitated by symptoms of congestive heart failure or angina. Patients with diabetes but without other conventional risk factors for atherosclerosis have a risk of death from CAD 2– 4 times that of age-matched controls.1– 4 Those with type 2 diabetes commonly have other associated risk factors, such as hypertension or hyperlipidemia, thus further increasing their cardiovascular risk. Women with diabetes are at increased risk, with a risk of cardiovascular death up to 7.5 times that of women without diabetes. Diabetic women do not have the premenopausal benefit seen in the general female population.2,3,5 Individuals with diabetes and CAD fare worse than do other pati Continue reading >>

Diabetes And Coronary Artery Disease

Diabetes And Coronary Artery Disease

Diabetes is a condition that affects how insulin is produced and used in the body. Insulin is a hormone that controls blood sugar . When you have diabetes , your body does not produce enough insulin or can't use it properly. Over time, this condition can speed up the hardening and narrowing ( atherosclerosis ) of the coronary arteries . This results in coronary artery disease . People who have diabetes are more likely to have coronary artery disease than people who do not have diabetes. If you have diabetes and coronary artery disease, there are things you can do to help lower your risk of a heart attack or stroke . Manage your diabetes and have a healthy lifestyle. Be active. Take medicines to lower blood pressure and cholesterol , and don't smoke. 1 Smith SC, et al. (2011). AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: A guideline from the American Heart Association and American College of Cardiology Foundation. Circulation, 124(22): 2458-2473. Also available online: Primary Medical ReviewerRakesh K. Pai, MD, FACC - Cardiology, Electrophysiology Specialist Medical ReviewerRobert A. Kloner, MD, PhD - Cardiology This information is not intended to replace the advice of a doctor.Healthwise disclaims any liability for the decisions you make based on thisinformation. 1995-2015 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. Continue reading >>

Diabetes And Coronary Heart Disease: A Risk Factor For The Global Epidemic

Diabetes And Coronary Heart Disease: A Risk Factor For The Global Epidemic

International Journal of Hypertension Volume 2012 (2012), Article ID 697240, 7 pages 1Division of Endocrinology, Department of Medicine, Loyola University Medical Center, 2160 South First Avenue, Fahey Bldg, Maywood, IL 60153, USA 2Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA 3Cardiovascular and Thoracic Surgery, University of Illinois at Chicago and Vanguard Weiss Memorial Hospital, 4646 North Marine Drive, Chicago, IL 60640, USA Academic Editor: Eoin O'Brien Copyright © 2012 Maguy Chiha et al. 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. Abstract Cardiovascular disease remains a leading cause of death in the United States and the world. In this we will paper focus on type 2 diabetes mellitus as a risk factor for coronary heart disease, review the mechanisms of atherogenesis in diabetics, the impact of hypertension and the treatment goals in diabetics, the guidelines for screening, and review the epidemiologic consequences of diabetes and heart disease on a global scale. The underlying premise to consider diabetes a cardiovascular disease equivalent will be explored as well as the recommendations for screening and cardiac testing for asymptomatic diabetic patients. 1. Introduction Cardiovascular disease is currently responsible for 30% of all deaths worldwide with most of the burden now occurring in developing countries [1]. After a peak around 1968, death from coronary heart disease (CHD) has declined significantly in the United States [2]. Based on a statistical mortality model previously validated in Europe, N Continue reading >>

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