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Diabetes and CAD

Diabetes and Coronary Artery Disease 

  • Diabetes and heart disease are inextricably intertwined; one tends to lead to the other within 10 to 20 years (Figure040).1, 2
  • People with diabetes and no heart disease have similar mortality as heart disease patients without diabetes after 10 years of diagnosis.3-5
  • The risk of cardiovascular disease (CVD) begins as early as 20 years before diabetes is diagnosed; it is already up to fourfold, 10 years before diabetes is detected. This finding supports the “ticking clock” hypothesis that CVD may begin before the onset of clinical diabetes.6
  • Both diabetes and heart disease are two deadly diseases that spring from a common soil and share an intermediary condition called metabolic syndrome (MS)─ a combination of three or more easily measured risk factors related to unhealthy lifestyle. SeeMetabolic Syndrome overview. 
  • Young adults with diabetes have rates of coronary artery disease (CAD) 12–40 times higher than those in people without diabetes.7 Subjects with diabetes  have been shown to have more advanced atherosclerosis.8 9, 10 High blood glucose is a greater risk factor for CAD and stroke than smoking.11
  • Compared to people without diabetes the risk of a heart attack is increased 3-fold in men and 10-fold in women <65 years of age.12 The risk is markedly increased in women who have both diabetes and MS─ a particularly deadly but common combination among Indian women.13 See MS and Women.
  • After a heart attack, people with diabetes have a 1.5 to 2 times higher death rate than those without.14
  • Diabetics have poor success and survival rates following angioplasty and bypass surgery. CAD mortality rates are twofold higher in people with diabetes compared to nondiabetic subjects and doubles for every 10 year increase in duration of diabetes.15-17

Sources

1.  Ali MK, Narayan KM, Tandon N. Diabetes & coronary heart disease: current perspectives. Indian J Med Res. Nov 2010;132(5):584-597.

2. Hu FB, Stampfer MJ, Haffner SM, Solomon CG, Willett WC, Manson JE. Elevated risk of cardiovascular disease prior to clinical diagnosis of type 2 diabetes. Diabetes Care. Jul 2002;25(7):1129-1134.

3. Chuang SY, Hsu PF, Sung SH, Chou P, Chen CH. Diabetes and 15-year cardiovascular mortality in a Chinese population: Differential impact of hypertension and metabolic syndrome. J Chin Med Assoc. May 2010;73(5):234-240.

4. Wannamethee SG, Shaper AG, Whincup PH, Lennon L, Sattar N. Impact of diabetes on cardiovascular disease risk and all-cause mortality in older men: influence of age at onset, diabetes duration, and established and novel risk factors. Arch Intern Med. Mar 14 2011;171(5):404-410.

5. Barnett KN, Ogston SA, McMurdo ME, Morris AD, Evans JM. A 12-year follow-up study of all-cause and cardiovascular mortality among 10,532 people newly diagnosed with Type 2 diabetes in Tayside, Scotland. Diabet Med. Oct 2010;27(10):1124-1129.

6. Haffner SM, Stern M, Hazuda H, Mitchell B, Patterson J. Cardiovascular risk factors in confirmed prediabetic individuals. Does the clock for coronary heart disease start ticking before the onset of clinical diabetes? Jama. 1990;263(21):2893-2898.

7. Booth GL, Kapral MK, Fung K, Tu JV. Relation between age and cardiovascular disease in men and women with diabetes compared with non-diabetic people: a population-based retrospective cohort study. Lancet. Jul 1 2006;368(9529):29-36.

8. Schurgin S, Rich S, Mazzone T. Increased prevalence of significant coronary artery calcification in patients with diabetes. Diabetes Care. Feb 2001;24(2):335-338.

9. Mazzone T, Chait A, Plutzky J. Cardiovascular disease risk in type 2 diabetes mellitus: insights from mechanistic studies. Lancet. May 24 2008;371(9626):1800-1809.

10. Mazzone T. Intensive glucose lowering and cardiovascular disease prevention in diabetes: reconciling the recent clinical trial data. Circulation. Nov 23 2010;122(21):2201-2211.

11. Danaei G, Lawes CM, Vander Hoorn S, Murray CJ, Ezzati M. Global and regional mortality from ischaemic heart disease and stroke attributable to higher-than-optimum blood glucose concentration: comparative risk assessment. Lancet. Nov 11 2006;368(9548):1651-1659.

12. Juutilainen A, Kortelainen S, Lehto S, Ronnemaa T, Pyorala K, Laakso M. Gender difference in the impact of type 2 diabetes on coronary heart disease risk. Diabetes Care. Dec 2004;27(12):2898-2904.

13. Mak KH, Ma S, Heng D, et al. Impact of sex, metabolic syndrome, and diabetes mellitus on cardiovascular events. Am J Cardiol. Jul 15 2007;100(2):227-233.

14. International Diabetes Federation. Diabetes and CVD Disease: A Time to Act. 2001. Brussels  2001.

15. Mohan V, Sandeep S, Deepa R, Shah B, Varghese C. Epidemiology of type 2 diabetes: Indian scenario. Indian J Med Res. Mar 2007;125(3):217-230.

16. Mulnier HE, Seaman HE, Raleigh VS, Soedamah-Muthu SS, Colhoun HM, Lawrenson RA. Mortality in people with type 2 diabetes in the UK. Diabet Med. May 2006;23(5):516-521.

17. Fox CS, Sullivan L, D’Agostino RB, Sr., Wilson PW. The significant effect of diabetes duration on coronary heart disease mortality: the Framingham Heart Study. Diabetes Care. Mar 2004;27(3):704-708.

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