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Diabetology for cardiologists

M. Laakso* and J. Kuusisto

Department ofMedicine, University of Kuopio, Kuopio, Finland

* Markku Laakso, MD, Professor and Chair, Department of Medicine, University of Kuopio, 70210 Kuopio, Finland.

Abstract

The number of diabetic people will be doubled worldwide in the following 10 years, due to an increase in the number of type 2 diabetic patients. Because type 2 diabetes increases the risk for cardiovascular disease by two- to fourfold, cardiovascular complications will become a major health problem. This review will focus on definition, classification and diagnostic criteria for diabetes, risk factors for type 2 diabetes, macrovascular complications of diabetes, and prevention and treatment of coronary heart disease in type 2 diabetic patients.

Key Words: Type 2 diabetes • diagnosis and classification • cardiovascular dioease • prevention

References

  1. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 1997;20:1183–1197[Web of Science][Medline]
  2. Alberti KGMM, Zimmet PZ, for the WHO Consultation. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. Provisional report of a WHO Consultation. Diabetic Med. 1998;15:539–553[CrossRef][Web of Science][Medline]
  3. Balkan B, Eschwege E, Tichet J, Marre M. Proposed criteria for the diagnosis of diabetes: evidence from a French epidemiological study. Diabetes Metab. 1997;23:428–434[Web of Science][Medline]
  4. Bennett PH, Burch TA, Miller M. Diabetes mellitus in American (Pima) Indians. Lancet. 1971;ii:125–128
  5. Zimmet PZ, Taft P, Guinea A, et al. The high prevalence of diabetes mellitus on a Central Pacific island. Diabetologia. 1977;13:111–115[CrossRef][Web of Science][Medline]
  6. Zimmet PZ. Kelly West Lecture: challenges in diabetes epidemiology: from West to the rest. Diabetes Care. 1992;15:232–252[Web of Science][Medline]
  7. O'Dea K. Westernisation, insulin resistance and diabetes in Australian Aborigines. Med J Aust. 1991;155:258–264[Web of Science][Medline]
  8. Harris MI, Flegal KM, Cowie CC, et al. Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults. Diabetes Care. 1998;21:518–524[Abstract]
  9. DeCourten M, Bennett PH, Tuomilehto J, Zimmet P. Epidemiology of NIDDM in non-Europids. alberti KGMM, Zimmet P, DeFronzo RA. International textbook of diabetes mellitus. 2nd edition. Chichester: Wiley; 1997. p. 143–170
  10. Yudkin JS, Alberti KGMM, McLarty DS, Swai H. Impaired glucose tolerance. Is it a risk factor for diabetes or a diagnostic ragbag? BMJ. 1990;301:397–401
  11. Mykkanen L, Laakso M, Uusitupa M, Pyörälä K. Prevalence of diabetes and impaired glucose tolerance in elderly subjects and their association with obesity and family history of diabetes. Diabetes Care. 1990;13:1099–1105[Abstract]
  12. Hales CN, Barker DJP. Type 2 (non-insulin-dependent) diabetes mellitus: the thrifty phenotype hypothesis. Diabetologia. 1992;35:595–601[CrossRef][Web of Science][Medline]
  13. McCance DR, Pettitt DJ, Hanson RL, et al. Birth weight and noninsulin-dependent diabetes: thrifty genotype, thrifty phenotype, or surviving small baby genotype? BMJ. 1994;308:942–945[Abstract/Free Full Text]
  14. Hu FB, Manson JE, Stampfer MJ. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. 2001;345:790–797[Abstract/Free Full Text]
  15. Boyko EJ, Fujimoto WY, Leonetti DL, Newell-Morris L. Visceral adiposity and risk of type 2 diabetes. A prospective study among Japanese Americans. Diabetes Care. 2000;23:465–471[Abstract]
  16. Tuomilehto J, Lindström J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344:1343–1350[Abstract/Free Full Text]
  17. National Institute of Diabetes and Digestive and Kidney Diseases. Diet and exercise dramatically delay type 2 diabetes. [press release], 31 October 2002 Accessed
  18. Pan X-R, Li G-W, Wang J-X, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance: the Da Qing IGT and Diabetes Study. Diabetes Care. 1997;20:537–544[Abstract]
  19. Stern MP. Diabetes and cardiovascular disease. The ‘common soil’ hypothesis. Diabetes. 1995;44:369–374[Abstract]
  20. Laakso M, Lehto S. Epidemiology of macrovascular disease in diabetes. Diabetes Rev. 1997;5:294–315
  21. Laakso M. Diabetes and cardiovascular disease in type 2 diabetes: challenge for treatment and prevention. J Intern Med. 2001;249:225–235[CrossRef][Web of Science][Medline]
  22. Haffner SM, Lehto S, Rönnemaa T, et al. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med. 1998;339:229–234[Abstract/Free Full Text]
  23. Gu K, Cowie CC, Harris MI. Diabetes and decline in heart disease mortality in US adults. JAMA. 1999;281:1291–1297[Abstract/Free Full Text]
  24. Miettinen H, Lehto S, Salomaa V, et al. Impact of diabetes on mortality after the first myocardial infarction. The FINMONICA Myocardial Infarction Register Study Group. Diabetes Care. 1998;21:69–75[Abstract]
  25. AnonymousLancet. 2001;357:995–1001[CrossRef][Web of Science][Medline]
  26. Laakso M. Hyperglycemia and cardiovascular disease in type 2 diabetes. Diabetes. 1999;48:937–942[Abstract]
  27. Coutinho M, Gerstein HC, Wang Y, Yusuf S. The relationship between glucose and incident cardiovascular events: a metaregression analysis of published data from 20 studies of 95 783 individuals followed for 12.4 years. Diabetes Care. 1999;22:233–240[Abstract/Free Full Text]
  28. Lempiäinen P, Mykkänen L, Pyörälä K, et al. Insulin resistance syndrome predicts coronary heart disease events in elderly nondiabetic men. Circulation. 1999;100:123–128[Abstract/Free Full Text]
  29. Bierman EL. Atherogenesis in diabetes. Atheroscler Thromb. 1992;12:647–656[Free Full Text]
  30. Lehto S, Rönnemaa T, Pyörälä K, Laakso M. Cardiovascular risk factors clustering with endogenous hyperinsulinaemia predict death from coronary heart disease in patients with type II diabetes. Diabetologia. 2000;43:148–155[CrossRef][Web of Science][Medline]
  31. Kuusisto J, Lempiainen P, Mykkanen L, Laakso M. Insulin resistance syndrome predicts coronary heart disease events in elderly type 2 diabetic men. Diabetes Care. 2001;24:1629–1633[Abstract/Free Full Text]
  32. Beckman JA, Creager MA, Libby P. Diabetes and atherosclerosis. Epidemiology, pathophysiology, and management. JAMA. 2002;287:2570–2581[Abstract/Free Full Text]
  33. De Vriese AS, Verbreuen TJ, Van de Voorde J, et al. Endothelial dysfunction in diabetes. Br J Pharmacol. 2000;130:963–974[CrossRef][Web of Science][Medline]
  34. Inoguchi T, Li P, Umeda F, et al. High glucose level and free fatty acid stimulate reactive oxygen species production through protein kinase C-dependent activation of NAD(P)H oxidase in cultured vascular cells. Diabetes. 2000;49:1939–1945[Abstract]
  35. Hattori Y, Kasai K, Nakamura T, et al. Effect of glucose and insulin on immunoreactive endothelin-1 release from cultured porcine aortic endothelial cells. Metabolism. 1991;40:165–170[CrossRef][Web of Science][Medline]
  36. Ferri C, Pittoni V, Piccof A, et al. Insulin stimulates endothelin-1 secretion from human endothelial cells and modulates its circulating levels in vivo. J Clin Endocrinol Metab. 1995;80:829–835[Abstract]
  37. Vague P, Juhan-Vague I. Fibrinogen, fibrinolysis and diabetes mellitus: a comment. Diabetologia. 1997;40:738–740[CrossRef][Web of Science][Medline]
  38. Vinik AI, Erbas T, Park TS, et al. Platelet dysfunction in type 2 diabetes. Diabetes Care. 2001;24:1476–1485[Abstract/Free Full Text]
  39. Laakso M. Epidemiology of diabetic dyslipidemia. Diabetes Rev. 1995;3:408–422
  40. Sniderman AD, Scandebury T, Ciaflone K. Hypertriglyceridemic hyperaboB: the unappreciated atherogenic dyslipoproteinemia in type 2 diabetes mellitus. Ann Intern Med. 2001;135:447–459[Abstract/Free Full Text]
  41. Williams KJ, Tabas I. The response-to-retention hypothesis of atherogenesis reinforced. Curr Opin Lipidol. 1998;9:471–474[CrossRef][Web of Science][Medline]
  42. Assman G, Cullen P, Jossa E, et al. Coronary heart disease: reducing the risk. Arterioscler Thromb Vasc Biol. 1999;19:1819–1824[Free Full Text]
  43. Collins T, Cybulsky MI. NF-kappaB: pivotal mediator or innocent bystander in atherogenesis? J Clin Invest. 2001;107:255–264[Web of Science][Medline]
  44. Bagg W, Ferri C, Desideri G, et al. The influences of obesity and glycemic control on endothelial activation in patients with type 2 diabetes. J Clin Endocrinol Metab. 2001;86:5491–5497[Abstract/Free Full Text]
  45. Basta G, Lazzarini G, Massaro M, et al. Advanced glycation end products activate endothelium through signal-transduction receptor RAGE: a mechanism for amplification of inflammatory responses. Circulation. 2002;105:816–822[Abstract/Free Full Text]
  46. Fukumoto H, Naito Z, Asano G, Aramaki T. Immunohistochemical and morphometric evaluations of coronary atherosclerotic plaques associated with myocardial infarction and diabetes mellitus. J Atheroscl Thromb. 1998;5:29–35
  47. Taguchi S, Oinuma T, Yamada T. A comparative study of cultures smooth muscle cell proliferation and injury, utilizing glycated low density lipoproteins with slight oxidation, auto-oxidation, or extensive oxidation. J Atheroscl Thromb. 2000;7:132–137
  48. Lusis AJ. Atherosclerosis. Nature. 2000;407:233–241[CrossRef][Medline]
  49. Ceriefo A, Giacomello R, Stel G, et al. Hyperglycemia-induced thrombin formation in diabetes. Diabetes. 1995;44:924–928[Abstract]
  50. Wagenknect LE, Bowden DW, Carr JJ, et al. Familial aggregation of coronary artery calcium in families with type 2 diabetes. Diabetes. 2001;50:861–866[Abstract/Free Full Text]
  51. Pajunen P, Nieminen MS, Taskinen M-R, Syvanne M. Quantitative comparison of angiographic characteristics of coronary artery disease in patients with noninsulin-dependent diabetes mellitus compare with matched nondiabetic control subjects. Am J Cardiol. 1997;80:550–556[CrossRef][Web of Science][Medline]
  52. Gyongyosi M, Yang P, Hassan A, et al. Coronary risk factors influence plaque morphology in patients with unstable angina. Coron Artery Dis. 1999;10:211–219[Web of Science][Medline]
  53. Silva JA, Escobar A, Collins TJ, Ramee SR, White CJ. Unstable angina. A comparison of angioscopic findings between diabetic and nondiabetic patients. Circulation. 1995;92:1731–1776[Abstract/Free Full Text]
  54. Moreno PR, Murcia AM, Palacios IF, et al. Coronary composition and macrophage infiltration in atherectomy specimens from patients with diabetes mellitus. Circulation. 2000;102:2180–2184[Abstract/Free Full Text]
  55. Pyörala K, Pedersen TR, Kjekshus J, et alfor the Scandinavian Simvastatin Survival Study (4S) Group. Cholesterol lowering with simvastatin improves prognosis of diabetic patients with coronary heart disease: a subgroup analysis of the Scandinavian Simvastatin Survival Study (4S). Diabetes Care. 1997;20:614–620[Abstract]
  56. Lancet. 2002;360:7–22[CrossRef][Web of Science][Medline]
  57. The Long-term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med. 1998;339:1349–1357[Abstract/Free Full Text]
  58. Hoogwerf BJ, Waness A, Cressman M, et al. Effects of aggressive cholesterol lowering and low-dose anticoagulation on clinical and angiographic outcomes in patients with diabetes. The Post Coronary Artery Bypass Graft Trial. Diabetes. 1999;48:1289–1294[Abstract]
  59. Rubins HB, Robins SJ, Collins D, et alfor the Veterans Affairs High-density Lipoprotein Cholesterol Intervention Trial Study Group. Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol. N Engl J Med. 1999;341:410–418[Abstract/Free Full Text]
  60. Diabetes Atherosclerosis Intervention Study Investigators. Effect of fenofibrate on progression of coronary artery disease in type 2 diabetes: The Diabetes Atherosclerosis Intervention Study, a randomised study. Lancet. 2001;357:905–910[CrossRef][Web of Science][Medline]
  61. Curb DJ, Pressel SL, Cutler JA, et alfor the Systolic Hypertension in the Elderly Program Cooperative Research Group. Effect of diuretic-based antihypertensive treatment on car diovascular disease risk in older diabetic patients with isolated systolic hypertension. JAMA. 1996;276:1886–1892[Abstract/Free Full Text]
  62. Tuomilehto J, Rastenyte D, Birkenhager WH, et al. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. N Engl J Med. 1999;340:677–684[Abstract/Free Full Text]
  63. Hansson L, Lindholm LH, Niskanen L, et alfor the Captopril Prevention Project (CAPPP) study group. Effect of angiotensinconverting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomised trial. Lancet. 1999;353:611–616[CrossRef][Web of Science][Medline]
  64. AnonymousLancet. 2000;355:253–259[CrossRef][Web of Science][Medline]
  65. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of microvascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ. 1998;317:703–713[Abstract/Free Full Text]
  66. Lindholm LH, Ibsen H, Dahlöf B, et al. Cardiovascular morbidity and mortality in patients with diabetes in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE). Lancet. 2002;359:1004–1010[CrossRef][Web of Science][Medline]
  67. UK Prospective Diabetes Study Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. UKPDS 33. Lancet. 1998;352:837–853[CrossRef][Web of Science][Medline]
  68. Malmberg K, Norhammar A, Wedel H, Ryden L. Glycometabolic state at admission: important risk marker of mortality in conventionally treated patients with diabetes mellitus and acute myocar dial infarction: long-term results from the Diabetes and Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) study. Circulation. 1999;99:2626–2632[Abstract/Free Full Text]
  69. The MIAMI Trial Research Group. Metoprolol In Acute Myocardial Infarction (MIAMI): a randomised placebo-controlled international trial. Eur Heart J. 1985;6:199–226[Abstract/Free Full Text]
  70. ISIS-1 (First International Study of Infarct Survival) Collaborative Group. Randomised trial of intravenous atenolol among 16 027 cases of suspected acute myocardial infarction. Lancet. 1986;ii:57–66
  71. Jonas M, Reicher-Reiss L, Boyko V, et alfor the Bezafibrate Infarction Prevention (BIP) Study Group. Usefulness of betablocker therapy in patients with non-insulin-dependent diabetes mellitus and coronary artery disease. Am J Cardiol. 1996;77:1273[CrossRef][Web of Science][Medline]
  72. Fibrinolytic Therapy Trialists' Collaborative Group. Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Lancet. 1994;343:311–322[CrossRef][Web of Science][Medline]
  73. Cohen M, Demers C, Gurfinkel EP, et al. A comparison of lowmolecular-weight heparin with unfractioned heparin for unstable coronary artery disease. N Engl J Med. 1997;337:447–452[Abstract/Free Full Text]
  74. Zuanetti G, Latini R, Maggioni AP, et al, GISSI-3 investigators. Effect of the ACE-inhibitor lisinopril on mortality in diabetic patients with acute myocardial infarction: the data from the GISSI study. Circulation. 1997;96:4239–4245[Abstract/Free Full Text]
  75. The Heart Outcomes Prevention Study Investigators. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med. 2000;342:145–153[Abstract/Free Full Text]
  76. Roffi M, Moliterano DJ, Meier B, et al. Impact of platelet glycoprotein IIb/IIIA receptor inhibitors among diabetic patients undergoing percutaneous coronary intervention: Do Tirofiban and ReoPro Give Similar Effect Outcomes Trial (TARGET) 1-year follow-up. Circulation. 2002;105:2730–2736[Abstract/Free Full Text]
  77. Stein B, Weintraub WS, Gebhart SSP, et al. Influence of diabetes mellitus on early and late outcome after percutaneous transluminal coronary angioplasty. Circulation. 1995;91:979–999[Abstract/Free Full Text]
  78. Kip KE, Faxon DP, Detre KM, et al. Coronary angioplasty in diabetic patients: the National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry. Circulation. 1996;94:1818–1825[Abstract/Free Full Text]
  79. Morris JJ, Smith LR, Jones RH, et al. Influence of diabetes and mammary artery grafting on survival after coronary bypass. Circulation. 1991;84(suppl 3):III275–III284
  80. Smith LR, Harrell FE, Rankin JS, et al. Determinants of early versus late cardiac death in patients undergoing coronary artery bypass graft surgery. Circulation. 1991;84(suppl III):III245–III253
  81. Alderman EL, Corleyy SD, Fisher LD, et al. The CASS Participating Investigators and Staff. Five-year angiographic follow-up of factors associated with progression of coronary artery disease in the Coronary Artery Surgery Study (CASS). J Am Coll Cardiol. 1993;22:1141–1154[Abstract]
  82. Herlitz J, Karlson BW, Wognsen GB, et al. Mortality and morbidity in diabetic and nondiabetic patients during a 2-year period after coronary artery bypass grafting. Diabetes Care. 1996;19:698–703[Abstract]
  83. Barsness GW, Peterson ED, Ohman EM, et al. Relationship between diabetes mellitus and long-term survival after coronary bypass and angioplasty. Circulation. 1997;96:2551–2556[Abstract/Free Full Text]
  84. Elezi S, Kastrad A, Pache J, et al. Diabetes mellitus and the clinical and angiographic outcome after coronary stent placement. J Am Coll Cardiol. 1998;32:1866–1873[Abstract/Free Full Text]
  85. Levine GN, Jacobs AK, Keeler GP, et al, CAVEAT-I Investigators. Impact of diabetes mellitus on percutaneous revascularization (CAVEAT-1). Am J Cardiol. 1997;79:748–755[CrossRef][Web of Science][Medline]
  86. The BARI Investigators. Influence of diabetes on 5-year mortality and morbidity in a randomized trial comparing CABG and PTCA in patients with multivessel disease: the Bypass Angioplasty Revascularization Investigation. Circulation. 1997;96:1761–1769[Abstract/Free Full Text]
  87. Detre KM, Lombardero MS, Brooks MM, et al, Bypass Angioplasty Revascularization Investigaton Investigators. The effect of previous coronary-artery bypass surgery on the progno sis of patients with diabetes who have acute myocardial infarction. N Engl J Med. 2000;342:989–997[Abstract/Free Full Text]
  88. Labinaz M, Madan M, O'Shea J, et al. Comparison of one-year outcomes following coronary artery stenting in diabetic versus nondiabetic patients (from the Enhanced Suppression of the Platelet II/IIIa Receptor with Integrilin Theprapy [ESPRIT] trial). Am J Cardiol. 2002;90:585–590[CrossRef][Web of Science][Medline]
  89. Roffi M, Chew DP, Mukherjee D, et al. Platelet glycoprotein IIb/IIIa inhibitors reduce mortality in diabetic patients with nonST-segment-elevation acute coronary syndromes. Circulation. 2001;104:2759–2761[Free Full Text]
  90. Abizaid A, Costa MA, Centemero M, Abizaid AS, et al. Clinical and economic impact of diabetes mellitus on percutaneous and surgical treatment of multivessel coronary disease patients: insights from the Arterial Revascularization Therapy Study (ARTS) trial. Circulation. 2001;104:533–538[Abstract/Free Full Text]

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