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Diabetes & HeartDiabetes & Heart
Conventional Cardiac risk factors… Conventional Cardiac risk factors… superimposed on the diabetic superimposed on the diabetic
statestate……
Hypertension
MicroalbuminuriaInactivity
South Asian origin
DyslipidaemiaObesity
……further accentuate atherosclerosis in the diabetic state…further accentuate atherosclerosis in the diabetic state…accounting for the excess Cardiac riskaccounting for the excess Cardiac risk
……further accentuate atherosclerosis in the diabetic state…further accentuate atherosclerosis in the diabetic state…accounting for the excess Cardiac riskaccounting for the excess Cardiac risk
Why does diabetes Why does diabetes predispose to atherosclerosis? predispose to atherosclerosis?
Metabolic abnormalities…in diabetesMetabolic abnormalities…in diabetesHigh blood sugarHigh blood sugar High lipidHigh lipid Insulin resistanceInsulin resistance
Alter the normal function of 3 different cell linesAlter the normal function of 3 different cell linesAlter the normal function of 3 different cell linesAlter the normal function of 3 different cell lines
ARTERYARTERYARTERYARTERY
Endothelial cell
Platelet
Smooth muscle
cell
……and their destruction leads to atherosclerosisand their destruction leads to atherosclerosis
Heart AttackHeart Attack
Which patient is at greater risk of future attack?
An attack survivor
A typical Type 2 diabetic
Risk Factors and C.H.D.Risk Factors and C.H.D.
6 year mortality per 1000.
0
10
20
30
40
50
60
0 1 2 3
Number of risk factors.
Diabetic
Non diabetic
Adapted from : Stamler; Diabetes Care,12,573 (1989)
Cholesterol. Smoking. Hypertension.
Heart AttackHeart AttackEqual riskEqual risk
An attack survivor
A typical Type 2 diabeticWithout heart problem
Atherosclerosis in TAtherosclerosis in T22DMDM
~80% of all people with Diabetes ~80% of all people with Diabetes dyingdying
75% from coronary atherosclerosis75% from coronary atherosclerosis 25% from cerebral or peripheral vascular 25% from cerebral or peripheral vascular
diseasedisease
>75% of all hospitalizations are for >75% of all hospitalizations are for diabetic complicationsdiabetic complications..
National Diabetes Data Group. Diabetes in America. 2nd ed. NIH;1995.
Death after MIDeath after MI
0
10
20
30
40
50
60
One Yr Two Yr Three Yr Four Yr Five Yr
DiabetesNo Diabetes
Herlitz J et al, Acta Med Scand 1988
Managing DiabetesManaging Diabetes : : 4 4 Cardinal Rules for the PatientCardinal Rules for the Patient
1. 1. Follow a healthy meal plan Follow a healthy meal plan 2. Regular exercise2. Regular exercise
3. Take your medication 3. Take your medication 4. Test your blood glucose regularly4. Test your blood glucose regularly