ABSTRACT
INTRODUCTION Patients with diabetes mellitus (DM) have a high prevalence of cardiac morbidity and mortality, with up to 75% of mortality being from cardiovascular disease (CVD).1,2
Specific vascular, myopathic and neuropathic alterations have been suggested as being responsible for the excessive cardiovascular (CV) morbidity and mortality in diabetes.3-5 These alterations manifest themselves clinically as coronary heart disease (CHD), congestive heart failure (CHF) and/or sudden cardiac death (SCD). Previous studies have shown that age-adjusted relative risk of death due to CV events in persons with diabetes is threefold higher than in the general population.1,6 Furthermore, diabetic patients without any history of CHD have the same risk of CHD death as a nondiabetic patient with a previous acute myocardial infarction (AMI).1 Diabetes acts as an independent risk factor for several forms of CVD. To make matters worse, when patients with diabetes develop clinical CVD, they sustain a worse prognosis for survival than do CVD patients without diabetes.1,7,8 Moreover, prospective studies9,10 show that not only diabetes, but also impaired glucose tolerance, is a risk factor for CVD. Diabetes is associated with a relatively greater risk of CVD in women than in men.11 Furthermore, women with diabetes seem to lose most of their inherent protection against developing CVD. When adjusted for other risk factors, the risk rate for increased mortality is 2.4 times greater for diabetic men and 3.5 times greater for diabetic women.2,11 Diabetes, notably type 2 diabetes, is on the rise in children and adolescents, thereby increasing the likelihood that they will develop premature CVD.
