What are the clinical manifestations of cardiovascular disease in diabetes? Ten year analysis from a clinic based population

Abstract

Aims

Cardiovascular disease may manifest as CHD, PVD and CbVD. Our aim was to explore these interactions and associated risk factors.

Methods

Patients were identified who attended clinic in 1990—1991 and remained under follow-up in 2000—2001. The latter were categorised by the presence/absence of manifest CHD, PVD and CbVD. Baseline clinic measurements (1990—1991) were studied in relation to CVD manifestations.

Results

Seven hundred and ninety-eight (CVD:358) patients were identified with follow-up. Of those with CVD: 51% had CHD, 14% PVD, and 9% CbVD exclusively. A further 17% had CHD+PVD, 4% CHD+CbVD, 2% PVD+CbVD, while 3% of patients had all three manifestations together. Increasing age, LDL-cholesterol and glucose were associated with increased risk of CHD, PVD and CbVD.

Conclusions

The majority of diabetic patients with CVD have $CHD (75%), and only 3% have a combination of CHD, PVD and CbVD.

Keywords

cardiovascular disease coronary heart disease peripheral vascular disease diabetes risk factors.

References

Orchard T. Diabetes: a time for excitement-and concern. BMJ 1998;317:691-2.

Amos AF , McCarty DJ , Zimmet P. The rising global burden of diabetes and its complications: Estimates and projections to the year 2010. Diabetic Med 1997;14(suppl 5):S1-S85.

Castelli WP , Garrison RJ , Wilson PW , Abbott RD , Kalousdian S. , Kannel WB Incidence of coronary heart disease and lipoprotein cholesterol levels. The Framingham study. JAMA 1986;256:2835-8.

Garcia MJ , McNamara PM , Gordon T. , Kannell WB Morbidity and mortality in diabetes in the Framingham population. Sixteen-year follow-up. Diabetes 1974;23:105-11.

Panzram G. Mortality and survival in type 2 (non-insulin-dependent) diabetes mellitus . Diabetologia 1987;30:123-31.

Stamler J. , Vaccaro N. , Neaton J. , Wentworth D. for the Multiple Risk Factor Intervention Trial Research Group. Diabetes, other risk factors and 12year cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care 1993;15:434-44.

American Diabetes Association. Consensus statement: Role of the cardiovascular risk factors in the prevention and treatment of macrovascular disease in diabetes. Diabetes Care 1989;12:573-9.

Goraya TY , Leibson CL , Palumbo PJ et al. Coronary atherosclerosis in diabetes mellitus-a population-based autopsy study. J Am Coll Cardiol 2002; 40:946-53.

CAPRIE Steering Committee. A randomised, blinded, trial of clopidrogel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 1996;348:1329-39.

10.

Ness J. , Aronow WS Prevalence of coexistence of coronary artery disease, ischemic stroke, and peripheral arterial disease in older persons, mean age 80 years, in an academic hospital-based geriatrics practice. J Am Geriatr Soc 1999;47:1255-6.

11.

Ness J. , Aronow WS , Ahn C. Prevalence of coronary artery disease, ischemic stroke, and symptomatic peripheral arterial disease and of associated risk factors in older men and women with and without diabetes mellitus. Prev Cardiol 2000;4:160-2.

12.

Ness J. , Aronow WS Prevalence of coronary artery disease, ischemic stroke, peripheral arterial disease, and coronary revascularisation in older African-American, Asians, Hispanics, Whites, Men, and Women. Am J Cardiol 1999;84:932-3.

13.

Turner RC , Millns H. , Neil HA et al. Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom Prospective Diabetes Study (UKPDS: 23). BMJ 1998;316:823-8.

14.

Bastyr EJ , Stuart CA , Brodows RG et al. Therapy focused on lowering postprandial glucose, not fasting glucose, may be superior for lowering HBA1c. Diabetes Care 2000;23:1236-41.

15.

The DECODE study group on behalf of the European Diabetes Epedemiology Group. Glucose tolerance and cardiovascular mortality. Comparison of fasting and 2-h diagnostic criteria. Arch Intern Med 2001;161:397-404.

16.

Bonora E. , Muggeo M. Postprandial blood glucose as a risk factor for cardiovascular disease in type II diabetes: the epidemiological evidence. Diabetologia 2001;44:2017-114.

17.

Struthers AD , Morris AD Screening for and treating left-ventricular abnormalities in diabetes mellitus: a new way of reducing cardiac deaths. Lancet 2002;359:1430-2.

18.

Hobbs FDR , Davis RC , Roalfe AK , Hare R. , Davies MK , Kenkre JE Reliability of N-terminal pro-brain natriuretic peptide assay in diagnosis of heart failure: cohort study in representative and high risk community populations . BMJ 2002;324:1-5.