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Diabetes and Cardiovascular Health: Understanding the Risk Factors and Prevention Strategies

Explore the close connection between diabetes and cardiovascular disease, highlighting the heightened risks faced by individuals with diabetes. Learn about the significant impact of hyperglycemia on cardiovascular health and the importance of early intervention to prevent premature death and complications. Discover the key biochemical mechanisms linking diabetes to cardiovascular risk factors and delve into the pathogenesis of increased cardiovascular events in diabetic patients. Uncover the critical role of insulin resistance in bridging the link between diabetes and cardiovascular diseases, emphasizing the need for proactive management strategies. Stay informed and take proactive steps towards safeguarding your cardiovascular health if you have diabetes.

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Diabetes and Cardiovascular Health: Understanding the Risk Factors and Prevention Strategies

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  1. Diabetes Mellitus: A state of premature cardiovascular death which is associated with chronic hyperglycemia and may also be associated with blindness and renal failure. Fisher BM. Diabetes Mellitus and myocardial infarction: a time to act or a time to wait? Diabetes Medicine. 1998, 15: 275

  2. Diabetes and CVD • In people with diabetes: • Heart disease strikes people with diabetes, twice as often as people without diabetes. • CVS complications occur at an earlier age and often result in premature death. • Diabetics are 2-4 times more likely to suffer strokes and once having had a stroke, are 2-4 times as likely to have a recurrence. • Deaths from heart disease in diabetic women have increased 23 %over the past 30 years compared to a 27 % decrease in women without diabetes. • Deaths from heart disease in men with diabetes have decreased by only 13 % compared to a 36 % decrease in men without diabetes.

  3. Glycemia Is a Cardiovascular Risk Factor: Plausible Biochemical Mechanisms

  4. Haffner Study 1998

  5. Haffner Study • Conclusions Our data suggest that diabetic patients without previous myocardial infarction have as high a risk of myocardial infarction as nondiabetic patients with previous myocardial infarction. These data provide a rationale for treating cardiovascular risk factors in diabetic patients as aggressively as in nondiabetic patients with prior myocardial infarction.

  6. CDV Events in Diabetes Patients: Framingham Study

  7. FPG and 2 – h Pg Predict Mortality in Persons Not Known to Have Type 2 Diabetes DECODE Study

  8. Relation between postprandial blood glucose levels and cardiovascular mortality

  9. DECODE: IGT Increases Mortality Risk Diabetes Epidemiology: Collaborative analysis Of Diagnostic criteria in Europe

  10. Hba1c Predicts MI in Type 2 Diabetes UKPDS 35

  11. Ticking Clock Hypothesis: Glucose Abnormalities Increase CV Risk Nurses Health Study, N=117.629 women, aged 30- 55 years follow – up 20 `years (1976 – 1996)

  12. Pathogenesis of Increased CVD in Diabetes • Metabolic Factors Hyperglycemia Lipids , lipoproteins FFA, insulin resistance • Hypertension

  13. Role of HYPERGLYCEMIA

  14. Hyperglycemia and Vascular Disease: Pathogenesis • Many aspects of coagulation impaired • Platelet behaviour abnormal: • Hypersensitive to stimuli • Clot lysis inhibited: • Higher Plasminogen activator inhibitor 1 levels • Fibrinogen levels elevated; Disordered kinetics

  15. Is it only Hyperglycemia?

  16. Insulin resistance

  17. Insulin resistance – the link between CVD and type 2 diabetes • Insulin resistance is an independent predictor of CVD2 • Insulin resistance is closely linked to a number of CVD risk factors3 • Insulin resistance may develop 20+ years before onset of type 2 diabetes:4 ~50% of newly diagnosed patients show signs of CVD5 • NCEP recognises type 2 diabetes as a coronary heart disease risk equivalent6 2Bonora E, et al. Diabetes Care 2002;25:1135–1141. 3Bonora E, et al. Diabetes 1998;47:1643–1649. 4Beck-Nielsen H & The EGIR. Drugs 1999;58(Suppl. 1):7–10. 5Laakso M. Int J Clin Pract Suppl 2001;121:8–12.6NCEP ATP III. JAMA 2001;285:2486–2497.

  18. Insulin resistance is linked to a range of CVD risk factors Insulin resistance Endothelial dysfunction Dyslipidaemia Hypertension Microalbuminuria Vascular inflammation Atherosclerosis CVD Adapted from McFarlane SI, et al. J Clin Endocrinol Metab 2001;86:713–718.

  19. Insulin resistance is an independent predictor of CVD in type 2 diabetes: The Verona Diabetes Complications Study 2.5 * * 2.0 1.5 * Odds ratio (95%) for incident CVD * 1.0 0.5 0.0 Insulin Smoking (yes vs. no) TC:HDL Age resistance (per unit) (per year) (per unit) Error bars = 95% CI *P < 0.001; n = 627 Adapted from Bonora E, et al.Diabetes Care 2002;25:1135–1141.

  20. Endothelial dysfunction correlates with insulin resistance 12 Control Type 2 diabetes Hypertension 10 8 Whole-body insulin sensitivity (MCR; ml/kg/min) 6 4 2 0 –20 0 20 40 60 Vasoreactivity (change in forearm blood flow ratio [%]) n = 27 r = 0.46, P < 0.05 Adapted from Cleland SJ, et al. Hypertens 2000;35:507–511.

  21. Low HDL is associated with hyperinsulinaemia 60 Hyperinsulinaemic Normoinsulinaemic 50 * * HDL-c (mg/dl) 40 30 20 Non-obese Obese Error bars = SE Adapted from Reaven GM. In: Diabetes Mellitus. LeRoith D et al., eds. Philadelphia: Lippincott-Raven; 1996:509–519. *P < 0.005

  22. Proportion of small dense LDL is associated with insulin resistance * (n = 52) (n = 29) (n = 19) Error bars = SD Mean (± SD) LDL diameter (Å): pattern A = 268 ± 4; intermediate = 261 ± 3; pattern B = 250 ± 4*P < 0.005–0.001 compared with pattern A or intermediate pattern Adapted from Reaven GM, et al. J Clin Invest 1993;92:141–146.

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