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6 Genesis Growth And Future of Cardiodiabetic Medicine

whitely et al were able to show that middle- aged pathogenesis of CVD in patients with Diabetes has
men and women with diabetes but no CAD were at improved, the incidence and prevalence of Diabetes
a lifetime vascular risk as high as individuals with has increased significantly as well. Shaw et al
CAD but no diabetes. However one of the most showed that the burden of Diabetes will increase
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important studies identifying diabetes as a CAD risk significantly from 2010 to 2030, with a 69% increase
conducted by schramm et al in 3.3 million Danish in adult Diabetes in developing countries, and a
residents, which showed that patients with diabetes 20% increase in developed countries; the associated
had a CVD risk comparable to those individuals populations increase is expected to be 36% and
without diabetes. All of these studies highlighted the 2% respectively. Based on these figures, the
notion that Diabetes should be considered a CAD risk diabetes burden will lead to increasing morbidity
equivalent. , mortality, stress on healthcare providers, and
healthcare –associated costs. A joint statement
The Framingham Offspring studies(FOS) have also by the American Heart Association and American
provided further insight into Insulin resistance as well Diabetes Associations in 2007 said that a multi-
as Diabetes as CVD risk factors. In 2002 Meigs et faceted approach including risk factor control as well
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al examined 3370 subjects from the Framingham as aggressive life-style changes must be employed
Offspring Cohort and found post-challenge to prevent the development of Diabetes and its
hyperglycemia as an independent risk factor for complications, most importantly CVD . 12
CVD .This is especially important since fasting
hyperglycemia has largely replaced post-challenge
hyperglycemia for diagnosing diabetes and several Incidence of CAD in General Population in
studies have shown that fasting hyperglycemia india
overlooks a significant number of people at risk The Registrar General of India reported that CHD led
for CVD who are identified using post –challenge to 17% of total deaths and 26% of adult deaths in
hyperglycemia. 2001-2003, which increased to 23% of total and 32%
of adult deaths in 2010-2013. In India, studies have
Additionally, other FOS have used data to identify
surrogate markers for CVD in Diabetics. Meigs et reported increasing CHD prevalence over the last 60
al found that participants with diabetes had more years, from 1% to 9%-10% in urban populations and
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coronary artery calcification than those without <1% to 4%-6% in rural populations
diabetes ,indicating a higher burden of subclinical Incidence of CAD in Diabetics: According to
CVD not detected by conventional testing . Similary, Cardiovascular diseases and Diabetes Association
other studies have shown that elevated levels there is a Definite Correlation of CAD in Diabetics,
of C-Reactive protein and Homocysteine are both The Prevalence is 68% of People with Diabetes of
associated with insulin resistance and an increased More than 10 years duration. 14
risk of CVD.
Presentation of CAD in Diabetics: Diabetics patients
Since the inception of the FHS, researchers have frequently present with silent myocardial infarction
tried to devise a score that would help predict the with absence of imperative warning symptoms.
risk of developing CAD based on risk factors. Truett ln regards to type of lesion involved in diabetics
et al were the first to utilize data from the FHS to compared with nondiabetic PTCA patients,
develop a risk score for men and women based diabetic patients have more extensive and diffuse
on seven risk factors: age, systolic blood pressure, atherosclerotic disease,most common being LAD
relative weight , hemoglobin, cigarette smoking ,and followed by RCA and Left circumfiex.
EKG evidence of LVH. Overtime, hemoglobin and
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LVH were removed glucose intolerance was Complications of Diabetes in CAD: Diabetes is
added, and the AHA published a book of risk associated independently with a 2-5 fold increased
tables in 1973. Eventually, in the 1991 a point scoring risk and incidence of Heart failure compared
system was developed to help clinicians risk – with those without Diabetes. The Increased
stratify patients and in 2008 a tool was developed for risk of Diabetes is multifactorial caused by
primary care physicians. Data from the Framingham ischemic metabolic and functional myocardial
Heart Study , therefore, were crucial in devising perturbation. Myocardial insulin resistance
the Framingham Risk Score to determine the 10- and cardiac complications of diabetes EDAbel
year risk of developing CAD. Current Drug Targets-Immune, Endocrine 2005
ingentaconnect.com
Even though our understanding of the

GCDC 2017