Details
Category: Volume 06 Issue 01 January 2018
Hits: 1229

Title: Cardiovascular disorders in Diabetes

Authors: Dr Santosh Kumar, Dr R.P.Gupta, Dr B.P.Singh

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i1.100

Abstract

Individuals with diabetes mellitus, both NIDDM and IDDM are at an increased risk for cardiovascular morbidity and mortality compared to non-diabetic subjects. The cardiac dysfunction in diabetes can be broadly classified as:

  • Atherosclerotic coronary heart disease
  • Cardiac autonomic neuropathy
  • Diabetic cardiomyopathy

In this review, we shall discuss briefly about the various mechanisms involved in cardiac dysfunction.

Atherosclerotic coronary heart disease

Diabetes in an independent risk factor for developing coronary artery disease (CAD)1. The overall prevalence of CAD is as high as 55% for adults with diabetes compared with a prevalence of 2-4% in general population. Data from Framingham Heart Study2 clearly demonstrates the increased risk and poor prognosis of, cardiac disease in diabetes. Mortality due to CAD is twice more common in diabetic men and quadrupled in diabetic women compared to their counterparts. The prevalence of angina, myocardial infarction and sudden death3 are more common in diabetics. Table 1 summarizes the quantum increase is major cardiovascular events due to CAD in diabetics compared to non-diabetics.

References

  1. Fein F, Scheuer J. Heart disease. In: Rufkin H, Prote D Jr, editiors. Diabetes mellitus: theory and practice. New York: Elsevier Science Publisher; 1990. P.812-3.
  2. Kannel WB, McGee DL. Diabetes and cardiovascular disease: the Framingham Study. JSMA 1979;241:2035-8.
  3. Fein FS. Heart diseases in diabetes. Cardiovasc Rev Rep 1982;3:8777-93.
  4. Mckeigue PM, Shah B, Marmot MG. Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians. Lancet 1991;337:382-6.
  5. Mohan V, Premalatha G, Sastry NG. Ischaemic heart disease in South Indian NIDDM patients. Intl J Diab Deb Countries 1995;15:64-7.
  6. Mckeigue PM, Miller GJ, Marmot MG. Coronary heart disease in South Asian overseas-a review. J Clin Epidemiol 1989;42:579-8.
  7. Hellie FR, Jamart J, Honore P, et al. Serum lipoprotein (a) in patients with diabetes mellitus, Diabetes Care 1993; 16:819-23.
  8. Jarett RJ. Why is insulin not a risk factor for coronary heart disease? Diabetologia 1994;37:945-7.
  9. Stout RW. Insulin and atheroma-20 year perspective. Diabetes Care 1990:13:631-54.
  10. Nagi DK, Hendra TJ, Ryle AJ, et al. The relationships of concentrations of insulin, intact proinsulin and 32-33 split prinsulin with cardiovascular risk factors in type 2 (Non insulin dependent) diabetic subjects. Diabetologia 1990;33:532-7.
  11. Landin K, Tengborn L, Smith U. Elevated firbrnogen and plasminogen activator inhibitor in hypertension are related to metabolic risk factor for cardiovascular disease. J Intern Med 1990;227:273-8.
  12. Mogenen CE. Midcroalbuminuria predicts clinical proteinuria and early mortality in maturity onset diabetes. N Engl J Med 1984;310:356-60.
  13. Jensen T, Stendir S, Deekert T. Abnormalities in plasma concentrations of lipoproteins and fibrinogen in type 1 (insulin dependent) diabetic patients with increased urinary albumin excretion. Diabetologia 1988.31;14
  14. Stamler J, Vacaro O, Neaton JD, Wentworth D. Multiple Risk Factor Intervention Trial Research Group, Diabetes, other risk factors and 12 year cardiovascular mortality for men screened in the multiple risk factor intervention trial. Diabetes Care 1993;16:434-44.

Corresponding Author

Dr Santosh Kumar

Assistant Professor Deptt. of Biochemistry

Nalanda Medical College, Patna