ABSTRACT
KEY POINTS ■ CVD is responsible for at least 50% to 60% of deaths in diabetes. ■ In 1991, the six-year post-MI survival in diabetes was 50% in men and 40% in women. ■ The prevalence of clinical CHD, stroke, and PVD is 40%, 10%, and 10% to 20%, respectively, in
middle-aged diabetic subjects. ■ Diabetic subjects without clinical CHD have 70% to 100% the MI risk of nondiabetic
subjects with evident CHD. ■ Approximately 20% to 25% of all subjects with CHD/stroke have known diabetes; a further 20%
have undiagnosed diabetes, and an additional 20% to 40% have IGT. ■ Atherogenesis is accelerated in subjects with type 2 diabetes, probably for years if not decades
prior to diagnosis ■ Pathophysiologic pathways, especially increased reactive oxygen species, drive accelerated
atherogenesis by producing ■ an activated, dysfunctional endothelium ■ up-regulation of inflammatory pathways in endothelial, monocyte/macrophage, and smooth
muscle cells ■ an increase in MMP activity ■ a procoagulant state
■ Implicated, though not clinically established, cardiovascular risk factors in diabetes ■ insulin resistance ■ obesity and altered adipocytokine release ■ increased FFA and lipotoxicity ■ hyperglycemia (controversial as to whether this is an established risk factor or not) ■ proinflammatory factors ■ hyperhomocysteinemia
■ Clinically established cardiovascular risk factors in diabetes ■ dyslipidemia ■ hypertension and increased arterial stiffness ■ hypercoagulability ■ cardiac dysfunction and dysautonomia ■ renal disease and microalbuminuria ■ smoking
■ A meta-analysis of epidemiologic studies demonstrated that hyperglycemia was a significant predictor of CVD.
