ReviewCardiovascular risk in diabetes: A brief review
Section snippets
Epidemiology of CVD morbidity and mortality
Examination of the natural histories of both types of diabetes reveals the significance of CVD in each. Data generated in the late 1980s from a cohort of 292 patients with type 1 diabetes followed for 20–40 years revealed an alarmingly high rate of coronary artery disease (CAD) and CAD mortality in this population. The cumulative mortality in the diabetic men and women was 3.5- to-4-fold higher than that of a cohort of similar aged non-diabetic population from the Framingham Heart Study, used
Hyperglycemia
A preponderance of evidence suggests that hyperglycemia is an important contributor to the increased CVD risk associated with diabetes. Hyperglycemia leads to glycation and peroxidation of proteins which, in animal studies, cause arterial damage, and it also has direct toxic effects on arterial walls. Logic dictates that exposure to hyperglycemia would enhance atherogenesis.
Many observational studies suggest that severity of hyperglycemia is an independent predictor of CVD. The Whitehall study
Effect of intensive glucose management
A number of prospective interventional studies support improvement in glycemic control as an important step toward reducing CVD risk. Conflicting data, however, do exist.
In type 1 diabetes, results of the DCCT showed a reduction in macrovascular complications in the intensively treated group of 41%, which is not a statistically significant difference (p=0.065), because of the small number of events in this young population. However, intensive management did reduce the development of
Relationship of insulin resistance to CVD risk
A number of studies have shown that hyperinsulinemia, a marker for insulin resistance, is associated with risk of CVD, even in the absence of diabetes. An Italian study in healthy persons with normal glucose tolerance showed that risk factors for CVD, such as high total and LDL-cholesterol levels, low HDL-cholesterol levels, and high blood pressure, were associated with hyperinsulinemia (Zavaroni et al., 1989). The Paris Prospective study, an 11-year study in 7028 diabetic and non-diabetic men,
Dyslipidemia and CVD risk
The Framingham Heart Study found that dyslipidemia was common in adults with diabetes, characterized most often by high triglyceride and low HDL-cholesterol levels (Garg & Grundy, 1990). This pattern occurs in both type 1 and type 2 diabetes, reflecting the basic pathogenic mechanism of lack of effective insulin action in each, either due to inadequate secretion or resistance. It is generally accepted, based on data from numerous studies, that dyslipidemia is an independent risk factor for CVD
Hypertension and cardiovascular risk in diabetes
Extensive data from a number of studies have demonstrated that tightly controlling blood pressure effectively reduces cardiovascular risk even more in the diabetic population than in the non-diabetic population. The results from the active treatment group of the Systolic Hypertension in the Elderly Program (SHEP) demonstrated reductions in rates for all major cardiovascular events of 34%, for stroke, 22%, and for MI, 56%, in older diabetic patients with isolated systolic hypertension (ISH)
Aspirin use and CVD reduction
There have been a number of trials of anti-platelet agents in populations at increased CVD risk. The HOT trial, described previously, included an evaluation of the benefits of aspirin use, and showed that, compared with placebo, the active treatment diabetic group had significant reductions in all major cardiovascular events of 15% and in MI of 46%. Reductions in risk for MI were also demonstrated in the Early Treatment Diabetic Retinopathy Study (EDTRS) (EDTRS Investigators, 1992).
Recommendations and perspective on risk factor reduction
Abundant data demonstrates that early aggressive control of glucose, blood pressure, and lipids is clearly beneficial in diabetic patients. The goals for risk factor reduction put forth by the American Diabetes Association, the American Heart Association, and others are summarized in Table 2.
Finally, a recent Finnish population-based study evaluating CVD risk in 1373 type 2 diabetic and 1059 non-diabetic subjects, with and without prior history of CVD, underlines the magnitude of the risk
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2017, Journal of Science and Medicine in SportElevated fasting serum insulin level predicts future development of hypertension
2014, International Journal of CardiologyCitation Excerpt :These findings suggest that elevated fasting insulin level can be an early predictor for hypertension. Especially, considering the clinical significance of hypertension as a definite causative factor for cardiovascular diseases, our study may be an etiologic background for previous studies showing increased cardiovascular risk in hyperinsulinemic, non-diabetic population [16–18]. Although there is still ongoing debate for relationship between fasting insulin level and BP, our findings correspond to previous reports sustaining the positive association between these 2 factors [19–23].