Impact of Diabetes on Cardiovascular Risk 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 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 130 80 mm Hg Fasting serum glucose 110 mg dl Validated with the WOSCOPS data Image Abnormalities Associated With the Metabolic Syndrome 114 KB File Type JPG Source ACCEL image provided by the American College of Cardiology Foundation IGT Insulin resistance Increased insulin resistance Fasting glucose Hyperglycemia Insulin secretion Hyperinsulinemia then b cell failure Adapted from International Diabetes Center IDC Minneapolis Minnesota Insulin Resistance and Cell Dysfunction Are Fundamental to Type 2 Diabetes Post prandial glucose Abnormal glucose tolerance NormalType 2 Diabetes 50 of Type 2 Diabetes Patients Have Complications at the Time of Diagnosis Retinopathy glaucoma or cataracts Nephropathy Neuropathy MICROVASCULARMACROVASCULAR 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 mg 24h p 0 001 ANOVA Segura et al JASN 2004 Ryden L et al Lancet 2002 Glucose and CV Risk Oral Glucose Tolerance Test All patients had experienced an MI n 300 At Hospital Discharge 12 Months Later Type 2 diabetics24 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 Unadjusted prevalence21 8 Age adjusted prevalence23 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 diabetes Adapted from Haffner SM New Engl J Med 1998 339 229 234 Risk of Myocardial Infarction Is Increased in Type 2 Diabetes 0 20 40 Risk of Fatal or Non Fatal Myocardial Infarction No prior myocardial infarction Prior myocardial infarction Non Diabetic Subjects Type 2 Diabetic Subjects n 1 304 60 69890169 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 010203040 Predicted Growth in the Prevalence of Diabetes WHO The World Health Report 1997 0 10 20 30 40 50 60 70 80 AfricaAmericas Eastern Med Europe Southeast Asia Western Pacific Year 1995 2000 2025 Estimated Prevalence In Millions Coronary Event Rates for Diabetic and Nondiabetic Participants Woscops