Cardiovascular implications of insulin resistance and non–insulin-dependent diabetes mellitus

Abstract

PATIENTS WITH TYPE 2 diabetes mellitus, or non–insulin-dependent diabetes mellitus (NIDDM), represent 10% to 15% of the population seen by physicians who regularly treat coronary artery disease (CAD). Given an increasing prevalence of NIDDM in developed countries and its association with obesity, high caloric intake, and sedentary lifestyle, 1 O'Rahilly S Science, medicine and the future: Non-insulin-dependent diabetes mellitus: The gathering storm. BMJ. 1997; 314: 955-959 Crossref PubMed Google Scholar , 2 Harris MI Hadden WC Knowler WC et al. Prevalence of diabetes and impaired glucose tolerance and plasma glucose levels in U.S. population aged 20-74 yr. Diabetes. 1987; 36: 523-534 Crossref PubMed Google Scholar , 3 Matthaei S Stumvall M Kellerer M et al. Pathophysiology and pharmacologic treatment of insulin resistance. Endocr Rev. 2000; 21: 585-618 Crossref PubMed Scopus (212) Google Scholar this percentage is almost certain to rise. In the 1980s, the Framingham study showed that the presence of NIDDM increased cardiovascular mortality 2-fold in men and almost 4-fold in premenopausal women. 4 Kannel WB McGee DL Diabetes and glucose tolerance as risk factors for cardiovascular disease: The Framingham Study. Diabetes Care. 1979; 2: 120-126 Crossref PubMed Google Scholar NIDDM adversely affects the natural history of CAD and the therapeutic benefits from percutaneous and surgical coronary revascularization procedures. 5 Brooks MM Jones RJ Bach RG et al. Predictors of morbidity and mortality from cardiac causes in the Bypass Angioplasty Revascularization Investigation (BARI) randomized trial and registry. Circulation. 2000; 101: 2682-2689 Crossref PubMed Google Scholar , 6 Kornowski R Mintz GS Kent KM et al. Increased restenosis in diabetes mellitus after coronary interventions is due to exaggerated intimal hyperplasia. Circulation. 1997; 95: 1366-1369 Crossref PubMed Google Scholar This adverse impact has been documented in all contemporary cardiovascular databases, 7 Stamler J Vaccaro O Neaton JD et al. Diabetes, other risk factors, and 12-year cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care. 1993; 16: 434-444 Crossref PubMed Google Scholar and the association between macrovascular disease (eg, myocardial infarction and stroke) and NIDDM has become stronger over time. 8 Zimmet PZ The changing face of macrovascular disease in non-insulin-dependent diabetes mellitus: An epidemic in progress. Lancet. 1997; 350: 1-4 Abstract Full Text Full Text PDF PubMed Google Scholar , 9 Nathan DM Meigs J Singer DE The epidemiology of cardiovascular disease in type 2 diabetes mellitus: How sweet it isor is it?. Lancet. 1997; 350: 4-9 Abstract Full Text Full Text PDF PubMed Google Scholar The pathophysiologic mechanisms responsible for this adverse impact are incompletely understood, however. Despite considerable improvements in pharmacologic and operative treatment of CAD, little improvement in outcome has occurred in these patients.