Diabetes and Cardiovascular Disease

At least 10.3 million Americans have been diagnosed with diabetes mellitus, and another 5.4 million are estimated to have undiagnosed diabetes. Onset often precedes diagnosis by several years.
About 90% of diabetic patients have Type II diabetes

Diabetes: Type II Diabetes and Insulin Resistance
Type II diabetes is most common form, occurring later in life, and involving combination of impaired insulin-mediated glucose disposal (insulin resistance) and defective secretion of insulin by pancreatic beta cells
Insulin resistance develops from obesity and physical inactivity and insulin secretion declines with advancing age (and accelerated by genetic factors)

Diabetes and the Dysmetabolic Syndrome
Insulin resistance often precedes type II diabetes and is often accompanied by other risk factors-- dyslipidemia, hypertension, and prothrombotic factors, the “dysmetabolic syndrome”
Impaired fasting glucose (110-125 mg/dl) often accompanies the dysmetabolic syndrome.
The threshold for fasting plasma glucose for diagnosis of diabetes has been lowered from 140 mg/dl to 126 mg/dl.

Diabetes: Complications
Cardiovascular diseases (CVD) account for about 65% of all deaths in diabetics; those with CVD have a worse prognosis than CVD patients without diabetes.
Complications include CHD, stroke, peripheral arterial disease, nephropathy, retinopathy, and possibly neuropathy and cardiomyopathy.
Stroke mortality 3-fold in diabetics vs. nondiabetics. Carotid atherosclerosis and likelihood of irreverisible brain damage from stroke more common in diabetics.
Renal impairment is a severe complication of diabetes; about 35% of pts with Type I diabetes have some renal impairment. End stage renal disease (ESRD) carries a high mortality (20%/year in dialysis pts) and is more common in Hispanics, blacks, and Native Americans

Potential Mechanisms of Atherogenesis in Diabetes
Abnormalities in apoprotein and lipoprotein particle distribution
Glycosylation and advanced glycation of proteins in plasma and arterial wall
“Glycoxidation” and oxidation
Procoagulant state
Insulin resistance and hyperinsulinemia
Hormone-, growth-factor, and cytokine-enhanced SMC proliferation and foam cell formation
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