Circulation. 2003;108:1655-1661
doi: 10.1161/01.CIR.0000089189.70578.E2
doi: 10.1161/01.CIR.0000089189.70578.E2
(Circulation. 2003;108:1655.)
© 2003 American Heart Association, Inc.
Review: Clinical Cardiology: New Frontiers |
Diabetes and Vascular Disease
Pathophysiology, Clinical Consequences, and Medical Therapy: Part II
From Cardiology, CardioVascular Center, University Hospital and Cardiovascular Research, Institute of Physiology, University Zürich, Switzerland (T.F.L., F.C.); Cardiology, II Faculty of Medicine, University "La Sapienza," Rome, and IRCCS Neuromed, Pozzilli, Italy (F.C.); and the Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass (M.A.C., J.A.B.).
Correspondence to Thomas F. Lüscher, MD, FRCP, Professor and Head of Cardiology, University Hospital, Rämistrasse 100, CH-8091 Zürich, Switzerland. E-mail cardiotfl@gmx.ch
Key Words: diabetes mellitus • revascularization • atherosclerosis • insulin • glucose
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
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Introduction |
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In Part I, we addressed the pathobiology linking diabetes mellitus and atherosclerosis.1 Diabetes is a major risk factor for cardiovascular morbidity and mortality. This condition increases the risk of developing coronary, cerebrovascular, and peripheral arterial disease up to 4-fold.2 Disease severity, as measured by chronic glycemia, is associated with an increasing frequency of clinical events in each vascular bed.3 The effect of diabetes on atherosclerosis is so pronounced that the benefit of female gender is eliminated in women with diabetes, who have an event rate similar to that of men with diabetes.4–6 Compared with patients without diabetes, those with diabetes have greater de novo disease progression and higher cardiovascular mortality rates.2,7,8 This part of the review will focus on clinical manifestations of and management strategies for atherosclerotic vascular disease in patients with diabetes.
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Clinical Manifestations of Atherosclerosis in Diabetes |
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Coronary Artery Disease
Diabetes is associated with a 2- to 4-fold increase in the risk of developing coronary artery disease. The risk of a myocardial infarction in patients with diabetes and no evidence of coronary artery disease matches that of patients without diabetes who have had a previous myocardial infarction.8 In the recent report of the Adult Treatment Panel of the National Cholesterol Education Program,9 type 2 diabetes mellitus was accorded a coronary artery disease risk-equivalent. In patients with known coronary artery disease and diabetes, the rates of death approach 45% over 7 years and 75% over 10 years.8 Outcomes are worse in diabetic patients for each manifestation of coronary artery disease. Diabetic patients presenting with unstable angina are more
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