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Cardio Diabetes Medicine 2017 65

ible brain damage with carotid emboli. subjects. In conclusion, asymptomatic South Asian
patients with type 2 DM have a higher prevalence
Difference in CVD between Diabetics and and extent of CAD compared with matched Cauca-
non diabetics. sian patients.
Patients with diabetes had a significantly higher cal- Approaches to diagnosis and treatment:
cium score compared to non-diabetics. Coronary ath- There is need to have a multi Pronged strategy to
erosclerosis was observed in 80% of diabetics and address the growing epidemic of DM and CVD.
almost half showed obstructive CAD.
A strategy of promotion of smoking/tobacco ces-
A large autopsy cohort of 293 diabetic decedents sation, physical activity, and healthy dietary habits
showed coronary atherosclerosis in almost 75% of in- should prevent risk factors from occurring in the first
dividuals, with 50% having diffuse multi-vessel CAD. place by providing information and an enabling en-
Since calcium deposition is related to the presence vironment for increasing awareness and adoption of
of atherosclerosis, coronary calcifications serve as a health living habits by the community
direct marker for CAD, and more severe plaques tend Primary prevention should focus on early detection of
to have a greater amount of calcium. persons with risk factors and cost-effective interven-
The type of coronary atherosclerosis may also differ tions for reducing risk by early screening and better
by ethnicity. A reappraisal of angiography studies in- control of risk factors (hypertension, hypercholester-
dicates that, compared to Europeans, South Asians olemia, and diabetes) to prevent incidence of overt
in the UK are more likely to have triple vessel dis- CHD.
ease, several lesions on angiography and non-dis- Early detection of persons with clinical disease and
crete. Compared with Caucasian patients, South cost-effective secondary prevention measures to pre-
Asian patients had a significantly higher coronary vent complications to prevent premature mortality
artery calcium score and higher prevalence of sig- and morbidity.
nificant CAD (41% vs 28%, respectively, p = 0.008),
involving more coronary vessels and segments. Sig-
nificant CAD was especially more frequent in the left
anterior descending coronary artery.
Observations of smaller proximal LAD luminal diame-
ters and higher mean percent stenosis among South
Asians compared with Caucasians could reflect more
diffuse atherosclerosis in the South Asian group.
South Asians have smaller coronary artery luminal
diameters compared to Caucasians and reiterates a
possible role of coronary artery size in affecting in-
creased CAD risk and mortality among South Asians.

Differences between Asians and other
ethnic groups(West), in diabetics:

Increased LAD stenosis, despite equivalent levels of
calcified disease, in South Asians is attributable to
narrower arteries. Reduced LAD diameter is asso-
ciated with advanced disease in Europeans but not
in South Asians, indicative of ethnic differences in
vascular remodelling. Prevalence of obstructive CAD
is less influenced by symptomatic status in diabet-
ics with respect to non-diabetics. Extensive Coronary
calcium score (>400) is more prevalent in diabetic pa-
tients than nondiabetic pts but absence of coronary
calcium does not reliably exclude atherosclerosis or
even obstructive CAD in patients at high cardiovas-
cular risk and this may be especially true for diabetic

Cardio Diabetes Medicine