Impact of Diabetes on Cardiovascular Risk
C.Richard Conti M.D. MACC
Oct 16,2004
GWICC
Beijing, PRC
Image ?(Prevention/Vascular)
Overlap of Four Common Conditions 25 KB???File Type: GIF
Diabetes and Cardiovascular Risk
An Association between diabetes mellitus and angina pectoris was first described in 1883, shortly after it was hypothesized that angina pectoris was due to atherosclerosis
Vergely P. De l’angine de poitrine dans ses rapports avec le diabete. Gaz hedb de ned (ser 2) 1883;20:364
Clinical Trial (INVEST) Blood Pressure Control
NCEP (ATP III) Definition of Metabolic Syndrome
3 of these 5 factors have to be present:
Increased waist circumference (>102 cm in men or >88 cm in women)
Hypertriglyceridemia (>150 mg/dl)
Low HDL-cholesterol (<40 mg/ml in men and 50 mg/ml in women)
Hypertension (BP >130/80 mm Hg)
Fasting serum glucose >110 mg/dl
(Validated with the WOSCOPS data)
?
Image ?
Abnormalities Associated With the Metabolic Syndrome 114 KB???File Type: JPG
IGT
Insulin resistance
Increased insulin resistance
Fasting glucose
Hyperglycemia
Insulin
secretion
Hyperinsulinemia,
then b-cell failure
Adapted from International Diabetes Center (IDC), Minneapolis, Minnesota
Insulin Resistance and ?-Cell Dysfunction Are Fundamental to Type 2 Diabetes
Post-prandial glucose
Abnormal
glucose tolerance
Normal
Type 2 Diabetes
50% of Type 2 Diabetes Patients Have Complications at the Time of Diagnosis
Retinopathy, glaucoma or cataracts
Nephropathy
Neuropathy
MICROVASCULAR
MACROVASCULAR
Cerebrovascular disease
Coronary heart disease
Peripheral vascular disease
UK Prospective Diabetes Study Group. UKPDS 33. Lancet 1998; 352: 837–853
Microalbuminuria in Metabolic Syndrome (MS) Patients
Microalbuminuria
mg/24h
p = 0.001 ANOVA
Segura et al JASN, 2004
Ryden L, et al. Lancet 2002;
Glucose and CV Risk (Oral Glucose Tolerance Test)
All patients had experienced an MI; n = 300
Age and gender adjusted CHD, CVD and total mortality in US adults with metabolic syndrome with and without diabetes and pre existing CVD. n=6255 Follow up 133 patient years. Malik et al Circ 2004;110:1245-1250
Prevalence of the Metabolic Syndrome Among U.S. Adults
Unadjusted prevalence 21.8%
Age-adjusted prevalence 23.7%
Prevalence increased with age
Mexican Americans had the highest prevalence (31.9%)
Ford ES, et al. JAMA 2002; 287: 356–9
Seven-year incidence in a Finnish-based cohort
* P < 0.001 vs no prior MI
? P < 0.001 vs no diabetes
Adapted from Haffner SM. New Engl J Med 1998; 339: 229–234
Risk of Myocardial Infarction Is Increased in Type 2 Diabetes
0%
20%
40%
Risk of Fatal or Non-Fatal Myocardial Infarction
No prior myocardial infarction
Prior myocardial infarction
Non-Diabetic Subjects
Type 2 Diabetic Subjects
*
n = 1,304
* ?
?
60%
69
890
169
Causes of Mortality in Diabetic Patients
Panzram G. Diabetologia 1987; 30: 123–31
Predicted Growth in the Prevalence of Diabetes
WHO. The World Health Report, 1997
Africa
Americas
Eastern
Med
Europe
Southeast
Asia
Western
Pacific
Year
1995
2000
2025
Estimated
Prevalence
In Millions
Coronary Event Rates for Diabetic and Nondiabetic Participants
Woscops