Cardiovascular Disease in Diabetes

Abstract

Perspectives on the News commentaries are part of a free monthly CME activity. The Mount Sinai School of Medicine, New York, New York, designates this activity for 2.0 AMA PRA Category 1 credits. If you wish to participate, review this article and visit www.diabetes.procampus.net to complete a posttest and receive a certificate. The Mount Sinai School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians . This article is based on presentations addressing aspects of cardiovascular disease in diabetic patients at the American Diabetes Association's 67th Scientific Sessions, 22–26 June 2007, in Chicago, Illinois; at the 55th Annual Advanced Postgraduate Course, 1–3 February 2008, in San Francisco, California (the course is available online at http://professional.diabetes.org); and at the Mount Sinai Medical Center Diabetes Grand Rounds, 14 February 2008, in New York, New York. At a symposium on the evaluation of cardiac ischemia and macrovascular disease in patients with diabetes held at the American Diabetes Association (ADA) meeting, Theodore Mazzone (Chicago, IL) discussed approaches to subclinical ischemia in diabetes. There is a well-established relationship between diabetes and adverse outcome, as first demonstrated in the East-West Study of a Northern European population with a 3.5% 7-year cardiovascular disease (CVD) mortality rate among nondiabetic individuals without a history of myocardial infarction. Subjects with a history of myocardial infarction had an 18.8% risk, while those without a history of myocardial infarction but with a history of diabetes had a 20.2% 7-year risk (1), forming the basis of the argument that type 2 diabetes is a coronary artery disease (CAD) equivalent. Subsequent trials comparing diabetic patients without known CVD to nondiabetic patients with CVD, Mazzone stated, have confirmed that “the risk is pretty close in most populations.” Schramm et al. (abstract 692) presented an …