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296 Cardio Diabetes Medicine 2017

Double Trouble -

Diabetes and Heart Disease (CAD)

Dr Preetam Arthur,
MD, FRCP,HOD OF MEDICINE,SRMC.CHENNAI

Dr. Harshavardhan TS, MD

1. Diabetes and Cardiovascular disease – and 48 years for men and women respectively with
epidemiology: diabetes. This was 15 years (mean) younger than that
of the non-diabetic population. Currently the Nation-
There is sufficient evidence to show that patients al cholesterol education programme from the United
with type 1 or type 2 diabetes mellitus are at a higher States of America and guidelines from Europe desig-
risk for cardiovascular disease than the normal pop- nate diabetes to be a coronary heart disease equiva-
ulation. These include coronary artery disease(CAD), lent, highlighting the highest risk category.
peripheral vascular disease, stroke, cardiomyopathy
and congestive cardiac failure. The public health sig- B. Extent of disease:
nificance of this association is emphasised in re- Studies have shown that the extent of coronary ar-
cent times due to the ‘diabetic epidemic’. With better tery disease is more among diabetics in comparison
treatment options, more people are living longer with to non diabetics. Multi vessel disease was more in
diabetes and this population is at a higher risk for patients with an acute myocardial infarction with dia-
cardiovascular disease due to advancing age. More- betes mellitus than in non diabetics (66% versus 46%)
over, lower levels of physical activity and lifestyle in the Thrombolysis and Angioplasty in myocardial
variations have seen the rise of obesity and diabetes infarction study. Even in asymptomatic patients this
among younger populations, putting them at a higher difference has been observed.
risk for cardiovascular disease as well.
C. Pattern of cardiovascular disease:
2. The effect of diabetes on cardiovascular Diabetes has been shown to be associated with as-
disease: ymptomatic vascular thrombogenesis, stable coro-
A. The strength of association nary artery disease, acute coronary syndromes, silent
ischemia and cardiomyopathy.
Diabetes mellitus has been recognised as an inde-
pendent risk factor for cardiovascular disease in mul- Acute myocardial infarction:
tiple prospective studies including the Framingham,
San Antonio and the Honolulu heart studies. In the Studies from Finland and the Atherosclerosis risk in
Framingham heart study the presence of diabetes Communities (ARIC) study from the United States
mellitus doubled the age adjusted risk for cardiovas- have established higher rates of acute myocardial
cular disease in men and tripled it in women. Diabe- infarction(MI) in patients with diabetes in comparison
tes was identified as a major independent risk factor to non diabetics. In the ARIC study the event rate of
even after adjusting for advancing age, hypertension, cardiac deaths or non fatal MI was higher in patients
hypercholesterolemia , left ventricular hypertrophy with diabetes alone (10.8%) and diabetes and prior MI
and smoking. A large database based retrospective (32.2%) compared to no diabetes and no MI (3.9%).
cohort study from Canada demonstrated that the Diabetics are also prone to higher rates of post in-
age of transition to a higher risk of cardiovascular farction angina and heart failure. (1) (2) The mortality
disease was much lower in diabetics than non dia- at 1 year post MI in diabetics has been shown to be
betics. This transition to a high risk category (10 year as high as 50% in some studies. The reason for this
event rate of more than 20 %) occurred at 41 years higher occurrence has been explained by the propen-

GCDC 2017