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