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Cardio Diabetes Medicine 2017 567

Tight Glycemic Control Decreases Cardio Vascular Mortality

(Proponent)

DR. M. SHUNMUGAVELU M.D.,
Specialist in Internal Medicine / Diabetologist / Chairman
Trichy Diabetes Speciality Centre (P) Ltd.,
Trichy-620017, Tamil Nadu, India

Introduction As another recent example, after 15 years of fol-
Diabetes and Cardiovascular events are known to be low-up in a population-based study of nearly 10,000
closely associated. In the presence of Diabetes, Car- individuals in Mauritius, Cardiovascular risk was
diovascular risk is increased by two-to-five-fold, de- greater in persons with Impaired Glucose Tolerance
pending on the population considered and the nature (IGT), newly diagnosed Diabetes or previously known
of the event. Given this association, management of Diabetes than in a group without glycemic abnormal-
patients with or at risk for Diabetes to improve Car- ities at baseline [1].
diovascular outcomes has received much attention.
However, the role of glycemic control continues to Inflammatory Cascade, Diabetes and
be debated [1]. Atherosclerosis
Atherosclerosis is a complex multifactorial disease,
Epidemiologic association between and the acceleration of atherosclerosis in Diabetes
Hyperglycemia and Cardiovascular Events may be explained by several conditions including hy-
Studies have shown that among persons with Dia- perglycemia, increased oxidative stress, AGE, dyslip-
betes, a higher HbA predicts worse outcomes. Re- idemia, autonomic imbalance, hyper-insulinemia, in-
1c
cent Studies show that persons with slightly elevat- flammatory markers excess and genetic variables [3].
ed glucose, which does not meet the definition of Adiponectin, has many protective actions in the
Diabetes also, have increased Cardiovascular risk. atherosclerosis process, is markedly reduced with
In an epidemiologic study of a population of more increased obesity and in Diabetes and hypo-adi-
than 6,50,000 Korean men, men with FPG above ponectinemia is associated with an increase in CVD
100 mg/dl had significantly higher risk of both Myo- rates [3].
cardial Infarction and Ischemic Stroke [1]. For each
18 mg/dl higher FPG, risk increased 11% for MI and Epigenetic reactions could be an important mediator
21% for Stroke. A Meta-Analysis including nearly between Diabetes, CVD and chronic inflammatory re-
7,00,000 individuals yielded similar results. Persons sponse. Besides, some comorbidities associated with
with known diabetes whose FPG was less than 126 Diabetes have also been associated with epigenetics
mg/dl had 61% higher risk than those without Dia- like hypertension and Obesity. The Epigenetic modi-
betes and FPG 70–100 mg/dl, whereas those with fications associated with hypertension are related to
known Diabetes and FPG higher than 126 mg/dl had intrauterine environmental factors which can limit the
136% increased risk[1]. development of the nephrons and to other factors
that are related to autonomic responsiveness, vessel
Similar findings are reported for HbA (A ) as an remodeling, salt sensitivity and to the Renin-Angio-
1c
1c
indicator of Glycemic status [1]. A recent report from tensin System[3].
continued long-term follow-up of a cross-section-
al US population of about 20,000 persons in the Recent studies have shown that dysregulation of the
NHANES confirms a much higher unadjusted car- Autonomic Nervous System (ANS) with increased
diovascular death rate among persons with diabetes sympathetic activity is associated with elevated in-
compared with those without diabetes [2]. flammatory markers such as IL-6 and CRP, demon-

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