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Type 1 Diabetes And Ischaemic Heart Disease

Extreme Ischaemic Heart Disease Risk In People With Type 1 Diabetes

Extreme Ischaemic Heart Disease Risk In People With Type 1 Diabetes

Observational studies show strong associations between diabetes and risk of ischaemic heart disease (IHD).1 Data, mainly from population-based cohorts in high-income countries, suggest that diabetes approximately doubles the risk of IHD, and this association may be doubled again in countries where healthcare resources to treat diabetes are limited.2 Diabetes associates with several known cardiovascular disease risk factors, but the persistence of this excess risk despite accounting for the effects of blood pressure, lipids and lifestyle factors (including smoking) suggests other important mediators of risk exist.1 Most large-scale observations of diabetes, glycaemic control and IHD have come from populations where type 2 diabetes predominates. In their Heart manuscript Matuleviciene Anängen and colleagues have studied IHD risk in type 1 diabetes and assessed how glycaemic control and reduced kidney function influence this risk.3 Studying these exposures in type 1 diabetes is an attractive strategy as the condition is often diagnosed in otherwise healthy young people without existing cardiovascular disease risk factors, and any reduced kidney function is likely a consequence of diabetes. This contrasts with type 2 diabetes, which generally develops later in life after possible prolonged exposure to other risk factors for IHD and chronic kidney disease (CKD), such as excess adiposity, high blood pressure or dyslipidaemias. This large and important study from the Swedish National Diabetes Register included observations from 33 000 people with type 1 diabetes, with an average age … Continue reading >>

Cardiovascular Disease Risk In Type 1 Diabetes

Cardiovascular Disease Risk In Type 1 Diabetes

Rachel Huxley and colleagues1 reported that type 1 diabetes confers a higher relative risk for all-cause mortality, incident stroke, fatal renal disease, fatal cardiovascular disease, and in particular incident coronary heart disease in women than in men. We have a few comments that might be of interest. Extensive evidence in this area refers mostly to type 2 diabetes and generally suggests that, relative to their counterparts without diabetes, women with diabetes are at a higher relative cardiovascular disease risk than are men. However, absolute risk (ie, when comparing men with diabetes with women with diabetes) might not differ.2, 3 During assessment of sex differences in the relation between glycaemia and cardiovascular disease risk, what matters is not whether women with diabetes are at higher relative risk of cardiovascular disease than are men, but whether women are at higher absolute risk, for any given level of glycaemia. In view of the apparent susceptibility of women to the effects of hyperglycaemia, as suggested by Huxley and coworkers,1 should glycaemic thresholds for diabetes be lower in women than in men? To resolve this possibility, definitive studies are needed that relate absolute risk for microvascular or macrovascular disease in women and men to actual levels of glycaemia, whether measured by fasting blood glucose or by HbA1c. The same arguments also apply when comparing cardiovascular disease risk factors: at any given level of glycaemia, do women have a worse risk factor profile than do men? Few studies clearly address these issues.2 Except for sex differences in cardiovascular disease risk factors for both type 1 and type 2 diabetes,4 another variable to consider is that women with diabetes are suboptimally treated compared with men regarding lip Continue reading >>

My Site - Chapter 23: Screening For The Presence Of Coronary Artery Disease

My Site - Chapter 23: Screening For The Presence Of Coronary Artery Disease

Compared to people without diabetes, people with type 1 and type 2 (especially women) are at higher risk of developing heart disease, and at an earlier age. Unfortunately, a large proportion will have no symptoms before either a fatal or a nonfatal myocardial infarction (MI). Hence, it is desirable to identify patients at high risk for vascular events, especially patients with established severe coronary artery disease (CAD). In individuals at high risk of CAD (based on age, gender, description of chest pain, history of prior MI, abnormal resting electrocardiogram and presence of several other risk factors), exercise stress testing is useful for the assessment of prognosis. Exercise capacity is frequently impaired in people with diabetes due tothe high prevalence of obesity, sedentary lifestyle, peripheral neuropathy (both sensory and motor) and vascular disease. For those unable to perform an exercise test, functional imaging testing, such as pharmacologic or nuclear stress imaging, may be required. Most imaging techniques have been shown useful in prospective study in order to identify patients at higher risk. However, there is, so far, no head-to-head study showing which one will be best in a cost-effective way. The majority (65% to 80%) of people with diabetes will die from heart disease (1,2) . Compared to people without diabetes, people with diabetes (especially women) are at higher risk of developing heart disease, and at an earlier age. A high proportion of deaths occur in patients with no prior signs or symptoms of cardiovascular disease (CVD). Furthermore, people with diabetes have a high prevalence of silent myocardial ischemia, and almost one-third of myocardial infarctions (MIs) occur without recognized or typical symptoms (silent MIs) (3) . The goals of s Continue reading >>

Cardiovascular Disease & Diabetes

Cardiovascular Disease & Diabetes

The following statistics speak loud and clear that there is a strong correlation between cardiovascular disease (CVD) and diabetes. At least 68 percent of people age 65 or olderwith diabetes die from some form of heart disease; and 16% die of stroke. Adults with diabetes are two to four times more likely to die from heart disease than adults without diabetes. The American Heart Association considers diabetes to be one of theseven major controllable risk factors for cardiovascular disease. Why are people with diabetes at increased risk for CVD? Diabetes is treatable, but even when glucose levels are under control it greatly increases the risk of heart disease and stroke. That's because people with diabetes, particularly type 2 diabetes,may have the following conditions that contribute to their risk for developing cardiovascular disease. High blood pressure has long been recognized as a major risk factor for cardiovascular disease. Studies report a positive association between hypertension and insulin resistance. When patients have both hypertension and diabetes, which is a common combination, their risk for cardiovascular disease doubles. Abnormal cholesterol and high triglycerides Patients with diabetes often have unhealthy cholesterol levels including high LDL ("bad") cholesterol, low HDL ("good") cholesterol, and high triglycerides. This triad of poor lipid counts often occurs in patients with premature coronary heart disease. It is also characteristic of a lipid disorder associated with insulin resistance called atherogenic dyslipidemia, or diabetic dyslipidemia in those patients with diabetes. Learn more about cholesterol abnormalities as they relate to diabetes. Obesity is a major risk factor for cardiovascular disease and has been strongly associated with insulin Continue reading >>

Diabetes And Coronary Heart Disease

Diabetes And Coronary Heart Disease

Diabetes Spectrum Volume 12 Number 2, 1999, Pages 80–83 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. Preface Coronary heart disease (CHD) is common in people with diabetes mellitus (DM).1 In the 197680 National Health and Nutrition Examination Survey II, the prevalence of angina was higher in people with than in those without diabetes.2 The 1989 U.S. National Health Interview Study showed a higher prevalence of CHD in people with diabetes.2 In the Multiple Risk Factor Intervention Trial, the age-adjusted incidence of CHD was four times greater in people with than in those without diabetes.3 In people with diabetes, CHD causes almost 60% of their deaths. They have a two- to threefold increased risk for CHD and two- to fourfold higher CHD morbidity and mortality rates. In people with diabetes, CHD occurs at a younger age, and women are affected as often as men. Glycemic Control and CHD In such a close relationship, does the degree of hyperglycemia increase the risk of developing CHD events or mortality? In people with type 1 diabetes, it does not, while in people with type 2 diabetes, a relationship appears to exist. In people with type 1 diabetes, the Pittsburgh Epidemiology of Diabetes Complications Study reported no association between glycosylated hemoglobin (HbA1c) and the 4-year incidence of CHD.4 In contrast, the incidence of CHD mortality and events increased with each tertile of HbA1c in elderly men with type 2 diabetes in Kuopio, Finland. The most important single risk factor associated with CHD death or event was HbA1c. This was present after adjusting for gender, history of previous myocardial infarction Continue reading >>

Heart Failure In Type 1 Diabetes: Frequent, Forgotten, And Fatal

Heart Failure In Type 1 Diabetes: Frequent, Forgotten, And Fatal

Heart Failure in Type 1 Diabetes: Frequent, Forgotten, and Fatal People with type 1 diabetes have a substantially increased risk of heart failure, according to a Swedish study published online September 18 in Lancet Diabetes & Endocrinology. The research also found that poor glycemic control and impaired renal function increase the risk of heart failure in this form of diabetes. Heart-failure experts have been warning for the past few years that diabetics have an increased risk of heart failure, but most prior work has not distinguished between type 1 and type 2 diabetes. This new study is the first to look specifically at the likelihood of heart failure in people with type 1 diabetes, compared with the general population, say the authors. "Our chief finding was that, even if still uncommon, people with type 1 diabetes had four times the risk of heart failure over an average of 8 years, compared with persons without type 1 diabetes from the general population," commented lead author Annika Rosengren, MD, PhD, professor of medicine at Sahlgrenska University, in Gteborg, Sweden. And "in the presence of poorly controlled diabetes, risk was more than 10 times that of controls, whereas heavy leakage of protein into the urine [macroalbuminuria, which indicates impaired renal function] was associated with more than 15-fold increase in risk," she pointed out. Diabetes represents an independent risk factor for heart failure. Although rare in youth, the implications of heart failure are "serious" when it does develop, according to Dr Rosengren. "Because heart failure usually occurs at an advanced age, when type 2 diabetes is by far the predominant type, the role of type 1 diabetes the type that afflicts children, adolescents, and young adults and that is not related to obesity o Continue reading >>

Being Female Is Not A Protective Factor Against Heart Disease In Type 1 Diabetes

Being Female Is Not A Protective Factor Against Heart Disease In Type 1 Diabetes

Follow all of ScienceDaily's latest research news and top science headlines ! Being female is not a protective factor against heart disease in type 1 diabetes Constrictions of the coronary blood vessels is a possible consequence of type 1 diabetes, and one that can eventually lead to myocardial infarction or heart failure. Generally speaking, women are afflicted by coronary artery disease later than men, but if a woman has type 2 diabetes, the advantage is negated. A new report now shows that this also sometimes applies to type 1 diabetes. Constrictions of the coronary blood vessels is a possible consequence of type 1 diabetes, and one that can eventually lead to myocardial infarction or heart failure. Generally speaking, women are afflicted by coronary artery disease later than men, but if a woman has type 2 diabetes, the advantage is negated. A new report by researchers from Karolinska Institutet, Gothenburg University and Uppsala University in Sweden published in the journal Diabetes Care now shows that this also sometimes applies to type 1 diabetes. There are few studies analysing the extent of coronary artery disease with coronary angiography in people with type 1 diabetes, most of which were conducted in the 1970s, 80s and 90s on seriously ill patients, revealing extensive constrictions of the coronary artery. Last year, researchers at Karolinska Institutet, Gothenburg University and Uppsala University conducted a large-scale study including all patients in Sweden -- just short of 2,800 in number -- with type 1 diabetes who had undergone coronary angiography between 2001 and 2013. The patients, 42 per cent of whom were woman, had had diabetes for an average of 35 years and had a mean age of 58. One fifth of the patients had normal coronary arteries, one fifth had Continue reading >>

Type 1 Diabetes Mellitus And Cardiovascular Disease: A Scientific Statement From The American Heart Association And American Diabetes Association

Type 1 Diabetes Mellitus And Cardiovascular Disease: A Scientific Statement From The American Heart Association And American Diabetes Association

Go to: Pathology of the Arterial Wall in T1DM There is developing interest in the way in which the pathology of atherosclerosis in patients with DM differs from those without DM and the way in which atherosclerotic lesions in T1DM differ from those in T2DM. In a study of atherectomy samples that did not distinguish DM type, patients with DM appeared to have lesions that were more laden with lipids, macrophages, and thrombus than nondiabetic patients (70). The data on atherosclerosis in T1DM are limited. A small angiographic study compared 32 individuals with T1DM to 31 nondiabetic patients matched for age and symptoms (71). That study found atherosclerosis in the setting of T1DM was characterized by more severe (tighter) stenoses, more extensive involvement (multiple vessels), and more distal coronary findings than in patients without DM. A quantitative coronary angiographic study in T1DM suggested more severe, distal disease and an overall increased burden compared with nondiabetic patients (up to fourfold higher) (72). When T1DM is compared with T2DM, the characteristics of the atherosclerosis may differ, although the data are very limited. In the study by Burke et al. (73) discussed above, there was overall lower atherosclerotic burden in T1DM than in T2DM, although the number of T1DM patients was relatively small (n = 16). An earlier autopsy study suggested plaques in T1DM were soft and fibrous and had a more concentric (less eccentric) location of lesions (74). A small computed tomography study comparing patients with T1DM to those with T2DM demonstrated similar CAC scores but more obstructive lesions, more noncalcified lesions, and more lesions overall in patients with T2DM than in those with T1DM (75). Techniques for demonstrating subclinical atherosclerosis, suc 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 >>

Prognosis Of Diabetic Patients With Coronary Heart Disease

Prognosis Of Diabetic Patients With Coronary Heart Disease

Article INTRODUCTION The Framingham study demonstrated that the presence of diabetes mellitus (DM) considerably increased cardiovascular risk, particularly in women.1 Since then, progress has continued until reaching the present concept, which considers that patients with type 2 DM have a risk of cardiovascular disease similar to that of patients with ischemic heart disease, peripheral arteriopathy, or cerebrovascular accident. Therefore, these patients must be handled according to the guidelines of secondary prevention, even in the absence of symptomatic ischemic heart disease. Likewise, prediabetic states, like glucose intolerance, which are characterized by resistance to the action of insulin, increase the risk of arteriosclerotic disease.2 On the other hand, DM is an important prognostic factor that is associated with more extensive coronary artery disease (CAD), a more aggressive course and greater morbidity and mortality than in coronary patients without DM.3 DM accelerates the process of atherogenesis through several mechanisms, such as anomalies in the lipoprotein concentration and composition, its association with hypertension, insulin resistance, and hyperinsulinemia, protein glycosylation in plasma and the arterial wall, lipid oxidation, a procoagulation and proinflammatory state, and disturbed endothelial function (Table 1).4 DM, prediabetic states, and their cardiovascular complications are one of the main epidemics of industrialized countries, with an enormous impact on healthcare. It is calculated that the direct and indirect healthcare expenses of DM are responsible for more than 15% of the national healthcare budget of the U.S.5 EPIDEMIOLOGY OF CORONARY ARTERY DISEASE IN DIABETES MELLITUS The prevalence of DM in the Spanish general population is approxi Continue reading >>

Diabetes And Heart Disease

Diabetes And Heart Disease

Tweet Heart disease is a complication that may affect people with diabetes if their condition is not managed well for a prolonged period of time.. Coronary heart disease is recognized to be the cause of death for 80% of people with diabetes, however, the NHS states that heart attacks are largely preventable. [48] How are heart disease and diabetes linked? People suffering from type 1 and type 2 diabetes are more likely to be at risk from heart attacks, strokes and high blood pressure. Vascular problems, such as poor circulation to the legs and feet, are also more likely to affect diabetes patients. Tweet Type 2 diabetes mellitus is a metabolic disorder that results in hyperglycemia (high blood glucose levels) due to the body: Being ineffective at using the insulin it has produced; also known as insulin resistance and/or Being unable to produce enough insulin Type 2 diabetes is characterised by the body being unable to metabolise glucose (a simple sugar). This leads to high levels of blood glucose which over time may damage the organs of the body. From this, it can be understood that for someone with diabetes something that is food for ordinary people can become a sort of metabolic poison. This is why people with diabetes are advised to avoid sources of dietary sugar. The good news is for very many people with type 2 diabetes this is all they have to do to stay well. If you can keep your blood sugar lower by avoiding dietary sugar, likely you will never need long-term medication. Type 2 diabetes was formerly known as non-insulin-dependent or adult-onset diabetes due to its occurrence mainly in people over 40. However, type 2 diabetes is now becoming more common in young adults, teens and children and accounts for roughly 90% of all diabetes cases worldwide. How serious i Continue reading >>

Coronary Heart Disease In Patients With Diabetes: Part I: Recent Advances In Prevention And Noninvasive Management - Sciencedirect

Coronary Heart Disease In Patients With Diabetes: Part I: Recent Advances In Prevention And Noninvasive Management - Sciencedirect

Volume 49, Issue 6 , 13 February 2007, Pages 631-642 Diabetes mellitus (DM) is a worldwide epidemic. Its prevalence is rapidly increasing in both developing and developed countries. Coronary heart disease (CHD) is highly prevalent and is the major cause of morbidity and mortality in diabetic patients. The purpose of this review is to assess the clinical impact of recent advances in the epidemiology, prevention, and management of CHD in diabetic patients. A systematic review of publications in this area, referenced in MEDLINE in the past 5 years (2000 to 2005), was undertaken. Patients with CHD and prediabetic states should undergo lifestyle modifications aimed at preventing DM. Pharmacological prevention of DM is also promising but requires further study. In patients with CHD and DM, routine use of aspirin and an angiotensin-converting enzyme inhibitor (ACE-I)unless contraindicated or not toleratedand strict glycemic, blood pressure, and lipid control are strongly recommended. The targets for secondary prevention in these patients are relatively well defined, but the strategies to achieve them vary and must be individualized. Intense insulin therapy might be needed for glycemic control, and high-dose statin therapy might be needed for lipid control. For blood pressure control, ACE-Is and angiotensin receptor blockers are considered as first-line therapy. Noncompliance, particularly with lifestyle measures, and underprescription of evidence-based therapies remain important unsolved problems. 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 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 >>

Type 1 Diabetes And Cardiovascular Disease

Type 1 Diabetes And Cardiovascular Disease

Abstract The presence of cardiovascular disease (CVD) in Type 1 diabetes largely impairs life expectancy. Hyperglycemia leading to an increase in oxidative stress is considered to be the key pathophysiological factor of both micro- and macrovascular complications. In Type 1 diabetes, the presence of coronary calcifications is also related to coronary artery disease. Cardiac autonomic neuropathy, which significantly impairs myocardial function and blood flow, also enhances cardiac abnormalities. Also hypoglycemic episodes are considered to adversely influence cardiac performance. Intensive insulin therapy has been demonstrated to reduce the occurrence and progression of both micro- and macrovascular complications. This has been evidenced by the Diabetes Control and Complications Trial (DCCT) / Epidemiology of Diabetes Interventions and Complications (EDIC) study. The concept of a metabolic memory emerged based on the results of the study, which established that intensified insulin therapy is the standard of treatment of Type 1 diabetes. Future therapies may also include glucagon-like peptide (GLP)-based treatment therapies. Pilot studies with GLP-1-analogues have been shown to reduce insulin requirements. Introduction Over the past 40 years, a reduction in the mortality due to cardiovascular (CV) disease and coronary heart disease (CHD) by about 70% both in diabetic and non-diabetic patients has been observed [1]. The cause is presumed to be a substantial progress in CV risk factor management and interventional cardiology [1]. Furthermore, in patients with type 1 diabetes, a decrease in mortality and a remarkable improvement in life expectancy occurred during the past decades [2, 3]. The comparison of two subcohorts of the Pittsburgh Epidemiology of Diabetes Complication Continue reading >>

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