Page 29 - fbkCardioDiabetes_2017

Cardio Diabetes Medicine 2017 5

(LVH) and other coronary risk factors. from the Fragigham Heart (FHS) to identify diabetes
as a major cardio vascular risk factor. It was also
3
The development of hypertension in a diabetic is an one of the first atusies to demonstrate the higher
intricate issue because of potential of development risk of CVD in women with Diabetes compared to
of intraglomerular hypertension (IGH) consequent to men with diabetes. Kannel et al used a cohort of
diabetic nephropathy, so that two concurrent circuits
13,8361 men and 18,928 women of 45 to 74 years of
of hypertension may develop in the same patient.
age at the time of the study who had been followed
These two circuits of hypertension, namely systemic biennially over a twenty year time period. In the 20
hypertension and IGH may not and go hand in hand. years of Follow- Up there were 957 cases of CVD,
Reduction of blood pressure in the systemic circuit which included 732 cases of coronary artery Disease
may not be associated with reduction of IGH with (CAD), 138 strokes,179 intermittent claudication. (IC),
4
consequent vicious circle of progressive nephron and 219 cases of congestive heart Failure (CHF).
loss. Thus, caution must be exercised in selecting Looking at the results comprehensively, men had a
an appropriate drug for hypertension in a diabetic. It higher incidence of CVD than women.
is important to bear in mind that reduction of blood Multiple stidied have followed the original Kannel
pressure in the systemic circuit will only provide publication in 1979 to better defined the role of
protection to the heart, brain, retina and peripheral Diabetes as a risk factor in cardiovascular Disease.
vascular system, but not to the kidneys The kidneys Re-Examination of the contribution of diabetes
will only be protected if IGH is lowered.
isespecially important since the defination of
diabetes has changed since publication of the
Genesis of Cardio Diabetology
original study, and the prevalence of Diabetes has
Cardiovascular Epidemiology began in the 1930s as increased dramatically fox et al. in 2006 showed
a consequence of observed changes in the causes that the incidence of the diabetes has also almost
of mortality in 1932,Whilem Raab Described the doubted between 1970 and 1990 further more even
Relationship between diet and coronary and heart though there has been a 50 % reduction in the rate
disease (CHD) in different region and in 1953 an of CVD among participants with diabetes from the
association between cholesterol levels and CHD FHS the relative risk of diabetis as a risk factor foe
mortality was reported in Various Populations. CVD has been unchanged. 5

In 1949 it was noted that “ the proper control of Additionaly since the kannel article other studies
Diabetes is obiviously describe even though there is have also looked at how the attributed risk (AR) has
uncertainty as to wheather coronary atherosclerosis changed overtime for diabetes and CVD. The AR for
is more frequent to severe in the uncontrol diabetic.” diabetes as a risk factor for CVD has increased from
In 1951 735 Finish men and women aged 25-74 5.4 % between 1952 and 1974 to 8.7 % between 1975
years, who where followed for an average 17 years, and 1998. The importance of this finding is highlighted
and comprising 9201 deaths, That combined hazards when other factors are observed as well; the AR for
6
ratio for coronary mortality, adjusted for other risk other factor has either decreased or remained stable.
factors,49 among men with MI only and with both Preis et al were able to utilize data from 1950 to 2005
diseases, were 2.1,4.0, and 6.4 respectively compared to look at trends in all – cause and CVD mortality in
with men without either disease. The corresponding both men and women with and without Diabetes . In
Hazards ratio for women were 4.9,2.5, and 9.4 haz- contrast to the NHANES study , this study showed
ards ratios for total mortality were 1.8,2.3,and 3.7 in a decline in all – cause and CVD mortality in both
men and 3.2,1.7, and 4.4 in women Diabetic men and men and women with diabetes. It also Showed that
women had comaparable mortality rates. Whereas men and women in the Diabetes continued to be
coronary Mortality among men was markedly high- at higher risk of CVD and all – cause mortality than
er. Thus,a History of Diabetes and MI Markedely in- those without Diabetes. These findings have been
creased CVD and all – cause mortality 2 supported and replicated in other studies as well as
showing a decrease in CVD mortality in men and
Relationship between Diabetes & CVD women with diabetes. 7
The role of Diabetes in CVD had been uncertain 1998 Haffner et al were able to show that Diabetic
until the prominent article published by kannel et patient without prior myocardial infarction (MI) were at
al in 1979 identified it as a major risk factor based a similar risk of developing MI those patient without
on evidence from the FHS, the seminal prospective Diabetes and history of MI. Further more in 2005
8
study CVD and its determinants .Kannel et used data

Cardio Diabetes Medicine