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4 Genesis Growth And Future of Cardiodiabetic Medicine

Metabolic Medicine CAD in Diabetics is not only frequent and occurs at a
younger age and women and the involvement is also
Metabolic Medicine is a sub-specialty within Internal
medicine which can be defined as a group of more extensive. Triple vessel disease and left main
overlapping areas of clinical practice with common stem lesion are more common. Intramural arteries are
dependence on detailed understanding of basic also involved producing, coronary microangiopathy.

biochemistry and metabolism. It therefore falls Silent myocardial ischemia and silent infarcts are
within the areas of expertise of both the physician more common. Pump failure, cardiogenic shock and
and chemical pathologist. reinfarction following acute myocardial infarction
(AMI) are distinctly higher in diabetes. Diabetic state
Metabolic Syndrome does not come in way of providing benefit by catheter
interventions or by bypass surgery but the necessity
The metabolic syndrome may be more useful when of a repeat procedure is higher in the long run.
considering prevention of the continuum from obesity
through diabetes to cardiovascular disease, whereas DC is another manifestation of cardiac involvement.
the term cardiodiabetes is more applicable to the It is a consequence of involvement of intramural
particular spectrum of cardiovascular disease, plus arteries without affection of epicardial coronary
more diffuse peripheral vascular and renal disease, arteries, but it also has extravascular component like
that is associated with diabetes. interstitial fibrosis and metabolic control of diabetes
also play an important part. In individuals after 35-
Diabetologists, cardiologists, lipidologists and renal 40 years, CAD may closely mimic DC and coronary
physicians joint specialist clinics run at hospital angiography is necessary to discriminate between
centres, Primary Care Trust (PCT) one-stop clinics. them. On occasions both may co-exist in the same
patients.
Life Style Medicine Sudden cardiac death (SCD) is the most dreadful
Lifestyle medicine is a scientific approach to complication and it is 1.8 times more common in men
decreasing disease risk and illness burden by utilizing and 3 times common is women compared to non-
lifestyle interventions such as nutrition, physical Diabetics. CAD, DC and autonomic cardiovascular
activity, stress reduction, rest, smoking cessation, neuropathy contribute to it. The availability of
and avoidance of alcohol abuse. Lifestyle medicine powerful antiarrhythmic drugs like Amiodarone and
is the recommended foundational approach to Automatic implantable cardiovertor defibrillator has
preventing and treating many chronic diseases.
greatly improved the prospects of survival.
Concept Note Recognition of Hypertension in Diabetics is
Cardio-Diabetology is fast emerging as a sub- of crucial importance because -
speciality throughout the globe to tackle the menace
of cardiac related mortality in Diabetes, particularly 1.It is a major risk factor for development and progress
NIDDM. of diabetic microangiopathy.
2.It is also a greater risk factor for the development
Cardiac involvement in Diabetes commonly manifests of macrovascular disease in a diabetic than in
as coronary artery disease (CAD) and less commonly nondiabetics.
as dilated cardiomyopathy (DC) and autonomic
cardiovascular neuropathy. CAD alone accounts, for 3.Diabetics with hypertension are prone for
the major chunk of mortality in diabetes. development of coronary heart disease. especially
when there is associated left ventricular hypertrophy
CAD is the leading cause of mortality in Diabetics. It
not only involves the epicardial coronary arteries but
also the intramural coronary arteries. Silent ischemic
events constitute a special feature of presentation.

CAD in Diabetics is multifactorial but dyslipidemia
has a major impact on it. The lipid profile in Indian’s
is different compared to the West and comprises
of normal or near normal total cholesterol and LDL
cholesterol with raised triglycerides and low HDL
cholesterol.

GCDC 2017