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How Does Diabetes Increase The Risk Of Coronary Heart Disease?

Diabetes Mellitus: A Major Risk Factor For Cardiovascular Disease

Diabetes Mellitus: A Major Risk Factor For Cardiovascular Disease

Abundant evidence shows that patients with type 1 diabetes or type 2 diabetes are at high risk for several cardiovascular disorders: coronary heart disease, stroke, peripheral arterial disease, cardiomyopathy, and congestive heart failure. Cardiovascular complications are now the leading causes of diabetes-related morbidity and mortality. The public health impact of cardiovascular disease (CVD) in patients with diabetes is already enormous and is increasing. Several explanations are behind this increase. First, the incidence of diabetes rises with advancing age, and the number of older people in the United States is growing rapidly. Second, insulin treatment for persons with type 1 diabetes has prolonged their lives significantly, and with each year of additional life comes an increased risk for CVD complications. Third, type 2 diabetes occurs at an earlier age in obese and overweight persons, and the prevalence of obesity is rising in the United States. The risk for diabetes in overweight persons is heightened by physical inactivity; unfortunately, the majority of Americans engage in little regular or sustained physical activity. Fourth, the populations that are particularly susceptible to diabetes—African Americans, Hispanics, Native Americans, Pacific Islanders, and Asians—are growing in this country. Fifth, improved medical care, particularly when extended to susceptible populations, will bring an increasing number of patients with type 2 diabetes into the medical care system. All of these factors will lead to an absolute increase in the number of patients who will require medical intervention to prevent the complications of diabetes. Diabetes has long been recognized to be an independent risk factor for CVD. Prospective studies, such as the Framingham, Honolulu 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 >>

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 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 >>

Gender Matters: Heart Disease Risk In Women

Gender Matters: Heart Disease Risk In Women

Heart disease is the leading cause of death among women — and one of the most preventable. Research is giving us insights into how we can control our risk. We've come a long way since the days when a woman's worry over heart disease centered exclusively on its threat to the men in her life. We now know it's not just a man's problem. Every year, coronary heart disease, the single biggest cause of death in the United States, claims women and men in nearly equal numbers. Risk still underappreciated In a survey conducted by the American Heart Association, about half of the women interviewed knew that heart disease is the leading cause of death in women, yet only 13% said it was their greatest personal health risk. If not heart disease, then what? Other survey data suggest that on a day-to-day basis, women still worry more about getting breast cancer — even though heart disease kills six times as many women every year. Why the disconnect? Breast cancer affects body image, sexuality, and self-esteem in ways that a diagnosis of heart disease does not. Also, heart disease tends to show up at an older age (on average, a woman's first heart attack occurs at age 70), so the threat may not seem all that real to younger women. Most 50-year-old women know women their age who've had breast cancer but none who've had heart disease. In addition, many women say their physicians never talk to them about coronary risk and sometimes don't even recognize the symptoms, mistaking them instead for signs of panic disorder, stress, and even hypochondria. Top heart attack symptoms in women One month before a heart attack During a heart attack Unusual fatigue (71%) Shortness of breath (58%) Sleep disturbance (48%) Weakness (55%) Shortness of breath (42%) Unusual fatigue (43%) Indigestion (39%) Continue reading >>

Risk Factors For Coronary Artery Disease

Risk Factors For Coronary Artery Disease

- So we know that coronary artery disease is when you get this build up of fatty plaques in different places in your coronary circulation, so, for example, I'm drawing in bits of this plaque, right? So bits of this atherosclerotic plaque building up in different parts of your coronary vessels, and these are going to cause coronary artery disease, right? These are going to lead to downstream pathologies, diseases like stable angina and acute coronary syndrome, so we know this is really bad, right? We don't really want coronary artery disease to be happening in our bodies, so is there anything we can do about this? Is there anything that we can do to stop or prevent these plaques from building up in our arteries? And, in fact, yes, yes there are somethings we can do, and we didn't always know that there was something we can do. Way back in the 1940s, I believe it is, the late 1940s, there's a study done called the Framingham Heart Study, and the Framingham Heart Study was pretty revolutionary. It showed that there were risk factors for it developing coronary artery disease, and, so, why is that revolutionary? Well, it means there's something we could potentially do to reduce the incidence of coronary artery disease, and that's really good because coronary artery disease is the leading cause of death of men and women in the U.S., so all this talk about risk factors. What exactly is a risk factor? Well, a risk factor is something that predisposes you to something else, so, for example, you could say that buying an iPhone six is a risk factor for not having very much money left in your wallet, or playing ice hockey against Canadians is a risk factor for losing the hockey game, if you're on the other team, but to bring it back to something more relevant, something like hypert Continue reading >>

Researchers Find Genetic Link Between Type 2 Diabetes, Coronary Heart Disease

Researchers Find Genetic Link Between Type 2 Diabetes, Coronary Heart Disease

NEW YORK (GenomeWeb) – An international study led by researchers from the Perelman School of Medicine at the University of Pennsylvania has identified new loci with ties to the etiology of both type 2 diabetes (T2D) and coronary heart disease (CHD). The team conducted a genome-wide, multi-ancestry study of genetic variation for T2D and CHD in order to evaluate the shared genetic origin of the two diseases. Continue reading >>

Markers Of Dysglycaemia And Risk Of Coronary Heart Disease In People Without Diabetes: Reykjavik Prospective Study And Systematic Review

Markers Of Dysglycaemia And Risk Of Coronary Heart Disease In People Without Diabetes: Reykjavik Prospective Study And Systematic Review

Abstract Associations between circulating markers of dysglycaemia and coronary heart disease (CHD) risk in people without diabetes have not been reliably characterised. We report new data from a prospective study and a systematic review to help quantify these associations. Methods and Findings Fasting and post-load glucose levels were measured in 18,569 participants in the population-based Reykjavik study, yielding 4,664 incident CHD outcomes during 23.5 y of mean follow-up. In people with no known history of diabetes at the baseline survey, the hazard ratio (HR) for CHD, adjusted for several conventional risk factors, was 2.37 (95% CI 1.79–3.14) in individuals with fasting glucose ≥7.0 mmol/l compared to those <7 mmol/l. At fasting glucose values below 7 mmol/l, adjusted HRs were 0.95 (0.89–1.01) per 1 mmol/l higher fasting glucose and 1.03 (1.01–1.05) per 1 mmol/l higher post-load glucose. HRs for CHD risk were generally modest and nonsignificant across tenths of glucose values below 7 mmol/l. We did a meta-analysis of 26 additional relevant prospective studies identified in a systematic review of Western cohort studies that recorded fasting glucose, post-load glucose, or glycated haemoglobin (HbA1c) levels. In this combined analysis, in which participants with a self-reported history of diabetes and/or fasting blood glucose ≥7 mmol/l at baseline were excluded, relative risks for CHD, adjusted for several conventional risk factors, were: 1.06 (1.00–1.12) per 1 mmol/l higher fasting glucose (23 cohorts, 10,808 cases, 255,171 participants); 1.05 (1.03–1.07) per 1 mmol/l higher post-load glucose (15 cohorts, 12,652 cases, 102,382 participants); and 1.20 (1.10–1.31) per 1% higher HbA1c (9 cohorts, 1639 cases, 49,099 participants). In the Reykjavik Study an Continue reading >>

Coronary Artery Disease

Coronary Artery Disease

Print Overview Coronary artery disease develops when the major blood vessels that supply your heart with blood, oxygen and nutrients (coronary arteries) become damaged or diseased. Cholesterol-containing deposits (plaque) in your arteries and inflammation are usually to blame for coronary artery disease. When plaque builds up, they narrow your coronary arteries, decreasing blood flow to your heart. Eventually, the decreased blood flow may cause chest pain (angina), shortness of breath, or other coronary artery disease signs and symptoms. A complete blockage can cause a heart attack. Because coronary artery disease often develops over decades, you might not notice a problem until you have a significant blockage or a heart attack. But there's plenty you can do to prevent and treat coronary artery disease. A healthy lifestyle can make a big impact. Symptoms If your coronary arteries narrow, they can't supply enough oxygen-rich blood to your heart — especially when it's beating hard, such as during exercise. At first, the decreased blood flow may not cause any coronary artery disease symptoms. As plaque continues to build up in your coronary arteries, however, you may develop coronary artery disease signs and symptoms, including: Chest pain (angina). You may feel pressure or tightness in your chest, as if someone were standing on your chest. This pain, referred to as angina, usually occurs on the middle or left side of the chest. Angina is generally triggered by physical or emotional stress. The pain usually goes away within minutes after stopping the stressful activity. In some people, especially women, this pain may be fleeting or sharp and felt in the neck, arm or back. Shortness of breath. If your heart can't pump enough blood to meet your body's needs, you may develo Continue reading >>

Does Supplemental Vitamin C Increase Cardiovascular Disease Risk In Women With Diabetes?1,2,3,4

Does Supplemental Vitamin C Increase Cardiovascular Disease Risk In Women With Diabetes?1,2,3,4

Abstract Background: Vitamin C acts as a potent antioxidant; however, it can also be a prooxidant and glycate protein under certain circumstances in vitro. These observations led us to hypothesize that a high intake of vitamin C in diabetic persons might promote atherosclerosis. Objective: The objective was to examine the relation between vitamin C intake and mortality from cardiovascular disease. Design: We studied the relation between vitamin C intake and mortality from total cardiovascular disease (n = 281), coronary artery disease (n = 175), and stroke (n = 57) in 1923 postmenopausal women who reported being diabetic at baseline. Diet was assessed with a food-frequency questionnaire at baseline, and subjects initially free of coronary artery disease were prospectively followed for 15 y. Results: After adjustment for cardiovascular disease risk factors, type of diabetes medication used, duration of diabetes, and intakes of folate, vitamin E, and β-carotene, the adjusted relative risks of total cardiovascular disease mortality were 1.0, 0.97, 1.11, 1.47, and 1.84 (P for trend < 0.01) across quintiles of total vitamin C intake from food and supplements. Adjusted relative risks of coronary artery disease were 1.0, 0.81, 0.99, 1.26, and 1.91 (P for trend = 0.01) and of stroke were 1.0, 0.52, 1.23, 2.22, and 2.57 (P for trend < 0.01). When dietary and supplemental vitamin C were analyzed separately, only supplemental vitamin C showed a positive association with mortality endpoints. Vitamin C intake was unrelated to mortality from cardiovascular disease in the nondiabetic subjects at baseline. Conclusion: A high vitamin C intake from supplements is associated with an increased risk of cardiovascular disease mortality in postmenopausal women with diabetes. Continue reading >>

Diabetic Retinopathy And The Risk Of Coronary Heart Disease

Diabetic Retinopathy And The Risk Of Coronary Heart Disease

The Atherosclerosis Risk in Communities Study Abstract OBJECTIVE— We sought to examine the relation of diabetic retinopathy to incident coronary heart disease (CHD). RESEARCH DESIGN AND METHODS— A population-based, prospective cohort study consisting of 1,524 middle-aged individuals with type 2 diabetes without prevalent CHD and stroke at baseline was conducted. Diabetic retinopathy signs were graded from retinal photographs according to the Early Treatment for Diabetic Retinopathy Study severity scale. Incident CHD events (myocardial infarction, fatal CHD, or coronary revascularization) were identified and validated following standardized protocols. RESULTS— In our study, 214 (14.7%) participants had diabetic retinopathy. Over an average follow-up of 7.8 years, there were 209 (13.7%) incident CHD events. After controlling for age, sex, race, study center, fasting glucose, A1C, duration of diabetes, blood pressure, antihypertensive treatment, cigarette smoking, BMI, and lipid profile, the presence of diabetic retinopathy was associated with a twofold higher risk of incident CHD events (hazard rate ratio [HR] 2.07 [95% CI 1.38–3.11]) and a threefold higher risk of fatal CHD (3.35 [1.40–8.01]). Further adjustments for inflammatory markers, carotid artery intima-media thickness, or nephropathy had minimal impact on the association. The increased risk of CHD was significant in both men (1.89 [1.08–3.31]) and women (2.16 [1.16–4.02]) with diabetic retinopathy. CONCLUSIONS— In individuals with type 2 diabetes, the presence of retinopathy signifies an increased CHD risk, independent of known risk factors. Our data support the role of microvascular disease in the pathogenesis of CHD in diabetes. Coronary heart disease (CHD) is a leading cause of mortality in ind Continue reading >>

Type 2 Diabetes Shares Risk Genes With Heart Disease

Type 2 Diabetes Shares Risk Genes With Heart Disease

Using genome data from more than 250,000 people, scientists have identified gene variants that appear to alter the risk of both type 2 diabetes and heart disease - two leading causes of death and disease. They also suggest that the discovery could lead to treatments that use one drug to protect against both illnesses. The international team, which was led by researchers from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, accounts for the findings in a paper published in the journal Nature Genetics. Around 95 percent of people with diabetes have type 2 diabetes, which is a disease that develops when the body makes enough insulin but its cells lose the ability to use it to absorb blood sugar and convert it into energy. The other 5 percent of diabetes cases are type 1 diabetes, which is a disease that develops when the body does not make enough insulin. If not controlled, diabetes results in high blood sugar, or hyperglycemia. This can lead to serious health problems such as heart disease, stroke, kidney disease, and vision impairment. In the United States, where it is the seventh leading cause of death, there are around 30.3 million adults with diabetes, including 25 percent of people who do not know that they have it. Diabetes and heart disease The number of adult diabetes cases has more than tripled in the U.S. in the past 20 years, primarily as a result of an aging population and rising levels of obesity. Worldwide, the prevalence of diabetes among adults has gone up from 4.7 percent in 1980 to 8.5 percent in 2014. Diabetes is a known risk factor for heart disease, which is the leading cause of death for both men and women in the U.S., where around 630,000 people die of the disease every year. Over half of people who die from heart d 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 >>

Diabetes And The Risk Of Coronary Heart Disease In The General Japanese Population: The Japan Public Health Center-based Prospective (jphc) Study

Diabetes And The Risk Of Coronary Heart Disease In The General Japanese Population: The Japan Public Health Center-based Prospective (jphc) Study

Jump to Section Abstract Objective Although diabetes has a great impact on coronary heart disease (CHD) in Western populations, there is limited evidence that diabetes influences CHD in the Japanese population. Methods The Japan Public Health Center-based prospective (JPHC) study conducted a follow-up of 31,192 individuals aged 40–69 years with no history of cardiovascular disease or cancer. Subjects were classified at baseline as normal, borderline diabetic or diabetic based on fasting and non-fasting blood glucose levels and the use of medication to treat diabetes. A Cox proportional hazards model was used to determine the association between diabetes and the risk of fatal and non-fatal CHD events after adjustment for potential confounders. Results During 12.9 years of follow-up (1990–2006), we identified 266 fatal and non-fatal coronary events using validated criteria. With normal individuals serving as a control, the hazard ratios for total incident CHD events after adjusting for sex, age, study community and fasting were 1.65 (95% CI, 1.19–2.29) and 3.05 (2.03–4.59) in the borderline and diabetic groups, respectively. These associations remained significant after adjustment for conventional risk factors. The population attributable fractions (PAF) of borderline diabetes and diabetes for CHD events were 6.9% and 6.3%, respectively. Furthermore, there was a trend for an association between an impaired fasting glucose (5.6–6.9 mmol/l) and an increased risk of CHD events. Conclusions This prospective study suggests that diabetes and elevated glucose levels are associated with incident CHD in the general Japanese population. The PAF of diabetes for fatal and non-fatal coronary events was estimated to be moderate. Continue reading >>

10 Risk Factors For Heart Disease

10 Risk Factors For Heart Disease

Some risk factors for heart disease can be controlled, and some can't. According to the American Heart Association, these are the leading factors that put you at risk for coronary artery disease or a heart attack. Age More than 83% of people who die from coronary heart disease are 65 or older. Older women are more likely to die of heart attacks within a few weeks of the attack than older men. Being male Men have a greater risk of heart attack than women do, and they have attacks earlier in life. Even after menopause, when women's death rate from heart disease increases, it's not as great as men's. Family history Those with parents or close relatives with heart disease are more likely to develop it themselves. Race Heart disease risk is higher among African Americans, Mexican Americans, American Indians, native Hawaiians, and some Asian Americans compared to Caucasians. Smoking Cigarette smoking increases your risk of developing heart disease by two to four times. High cholesterol As blood cholesterol rises, so does risk of coronary heart disease. High blood pressure High blood pressure increases the heart's workload, causing the heart to thicken and become stiffer. It also increases your risk of stroke, heart attack, kidney failure, and congestive heart failure. When high blood pressure exists with obesity, smoking, high blood cholesterol levels, or diabetes, the risk of heart attack or stroke increases several times. Sedentary lifestyle Inactivity is a risk factor for coronary heart disease. Excess weight People who have excess body fatespecially if a lot of it is at the waistare more likely to develop heart disease and stroke even if they have no other risk factors. Diabetes Having diabetes seriously increases your risk of developing cardiovascular disease. About thre Continue reading >>

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