Impact of Diabetes on Cardiovascular Risk

C.Richard Conti M.D. MACCOct 16,2004

GWICCBeijing, PRC

Image  (Prevention/Vascular)Overlap of Four Common Conditions

25 KB   File Type: GIF

    

 

Source

 

ACCEL image provided by the American College of Cardiology Foundation

 

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

IINNVVEESSTT11 yyeeaarr

SBP<140

SBP<130

DBP<90

DBP<85

Non-Diabetics

67% 89%

Diabetics 62% 90%

Diabetics 34% 83%

NCEP (ATP III) Definition of Metabolic Syndrome

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 Syndrome114 KB   File Type: JPG

    

 

Source

 

ACCEL image provided by the American College of Cardiology Foundation

 

IGT

Insulin resistance

Increased insulinresistance

Fasting glucose Hyperglycemia

Insulinsecretion

Hyperinsulinemia,then b-cell failure

Adapted from International Diabetes Center (IDC), Minneapolis, Minnesota

Insulin Resistance and -Cell Dysfunction Are Fundamental to Type 2 Diabetes

Insulin Resistance and -Cell Dysfunction Are Fundamental to Type 2 Diabetes

Post-prandial glucose

Abnormalglucose tolerance

Normal Type 2 Diabetes

50% of Type 2 Diabetes Patients Have Complications at the Time of Diagnosis50% 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 in Metabolic Syndrome (MS) Patients

0

20

40

60

80

MS Normoglycemic MS Glucose Intolerance MS Diabetes

Mic

roal

bu

min

uri

am

g/2

4h

p = 0.001 ANOVA

Segura et al JASN, 2004

Ryden L, et al. Lancet 2002;

Glucose and CV Risk (Oral Glucose Tolerance Test)

Glucose and CV Risk (Oral Glucose Tolerance Test)

All patients had experienced an MI; n = 300

At Hospital Discharge

12 Months Later

Type 2 diabetics 24% 36%

Impaired glucose tolerance

41% 32%

Normal glucose tolerance

35% 32%

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

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 diabetesAdapted from Haffner SM. New Engl J Med 1998; 339: 229–234

Risk of Myocardial Infarction Is Increased in Type 2 Diabetes

0%

20%

40%

Ris

k o

f F

atal

or

No

n-F

atal

M

yoca

rdia

l In

farc

tio

nNo prior myocardial infarctionPrior 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

% Deaths in Diabetic Patients

Not Specified

Others

Tuberculosis

Accident/Suicide

Gangrene

Renal Insufficiency

Diabetic Coma

Infections

Tumours

Stroke

Myocardial Infarction

0 10 20 30 40

Predicted Growth in the Prevalence of Diabetes

WHO. The World Health Report, 1997

0

10

20

30

40

50

60

70

80

Africa Americas EasternMed

Europe SoutheastAsia

WesternPacific

Year

1995

2000

2025

EstimatedPrevalenceIn Millions

Coronary Event Rates for Diabetic and Nondiabetic Participants Woscops