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74 Cardio Diabetes Medicine 2017

Diabetes and Heart Are Inseparable Partners

- How & Why

Prof. Dr. Elango, MD.,
&

Dr. Sam Paul Wesley

Diabetic people have an increased prevalence as fuse atherosclerotic lesions . Cardiac catheterizations
well as morbidity & mortality of cardiovascular dis- in diabetic patients have shown significantly more
eases —most commonly in the form of coronary heart severe proximal and distal CHD. In addition, plaque
disease (CHD).There exists a need for the under- ulceration and thrombosis have been found to be
standing of the pathophysiological processes behind significantly higher in diabetic patients. The protec-
these states and also the need for mitigating them, tion that premenopausal women have against CHD
leading onto improved management of diabetes re- is not seen if they suffer from diabetes. The degree
lated heart diseases. Their association not only lies and duration of hyperglycemia are strong risk factors
in the evolution of disease state but also in medical for the development of microvascular and macro-
& interventional management of those morbidities af- vascular complications. The first detectable sign of a
fecting the success rate in treatment. Eighty percent problem in people genetically prone to develop type 2
of all deaths among diabetic patients are a result of diabetes is insulin resistance, which can be seen for
atherosclerosis, compared with approximately 30% as long as 15 to 25 years before the onset of diabe-
among nondiabetic persons.Among all hospitaliza- tes. Several atherogenic factors are associated with
tions for diabetic complications, >75% are a conse- insulin resistance, which can start the atherosclerotic
quence of atherosclerosis. Despite overall improve- process years before clinical hyperglycemia ensues.
ments in outcomes during the past several decades It is unclear whether the compensatory hyperinsu-
for patients with , the gradient of risk associated with linemia plays a role in atherosclerosis generation in
diabetes has persisted.This partnership of diabetes insulin-resistant patients. A number of prospective
with cardiac morbidity should be broken completely studies have shown an association between fast-
so as to reduce the impact on health,social and eco- ing or postprandial hyperinsulinemia and the future
nomical burden on the world and becomes a public development of CHD. Hyperglycemia itself plays an
health imperative. important role in enhancing the progression of ath-
erosclerosis in type 2 diabetes. The threshold above
TEXT: which hyperglycemia becomes atherogenic is not
Diabetes mellitus has an extensive negative effect known but may be in the range defined as impaired
on the heart and the circulatory system mainly due glucose tolerance (ie, fasting plasma glucose level
the “high glucose” levels and the actions of the the <126 mg/dL with 30-, 60-, or 90-minute plasma glu-
advanced end glycation products produced due to it. cose concentrations >200 mg/L and a 2-hour plas-
The primary disease states of heart associated with ma glucose level of 140-200 mg/dL during an oral
diabetes include , accelerated atherosclerosis, coro- glucose tolerance test).
nary heart disease (CAD), acute coronary syndromes The mechanism implicated with the development of
, heart failure and cardiomyopathy. coronary vasculature affliction in diabetic patients
include :
Atherosclerosis & CAD:
Endothelium
Diabetes accelerates the natural course of athero-
sclerosis in all groups of patients and involves a ↑ NF-κB(Nuclear factor-kappa beta) activation
greater number of coronary vessels with more dif-

GCDC 2017