Abstract
The overbearing financial burden imposed by the U.S. healthcare system is a complex problem which must be addressed soon. Diabetes, with its multiple cardiovascular sequelae, is currently one of the largest contributors and threatens to worsen as the obesity epidemic blossoms. The implications of atherosclerosis and hypertension related to diabetes may take years to become evident, making the overall disease process a particularly insidious one. Similarities between the biochemical mechanisms of vascular damage in diabetes may someday be the key to preventing its significant morbidity. Until we are able to capitalize on the similarities in the development of complications of hyperglycemia, preventative medicine should be the focus. Lessons should be learned from the widespread success of anti-tobacco legislation and educational programs in decreasing the prevalence of smoking and subsequent pulmonary disease. New York has already passed legislation limiting the size of sugary drinks that can be sold in the city. Efforts should be made to redirect care from the end stages of this particular disease to preventing it in the lower socioeconomic class, where poor diet may be more of an issue.
Highlights
The cardiovascular complications of diabetes are mainly responsible for its significant morbidity and mortality and the abundant cost of diabetes to the U.S healthcare system
In a study by Boyle et al, assuming the increasing incidence of diabetes imposed by the obesity epidemic continues, the prevalence of diabetes could increase from 14% to a third of the U.S population by 2050 [3,4]
Hyperglycemia that results from insulin resistance and deficiency increases the rate of advanced glycosolation end product (AGE) formation, decreases nitric oxide (NO) levels, and activates protein kinase C (PKC) resulting in apoptosis, decreased intrinsic endothelial vasodilation, and impaired cellular function
Summary
The cardiovascular complications of diabetes are mainly responsible for its significant morbidity and mortality and the abundant cost of diabetes to the U.S healthcare system. Hyperglycemia that results from insulin resistance and deficiency increases the rate of advanced glycosolation end product (AGE) formation, decreases nitric oxide (NO) levels, and activates protein kinase C (PKC) resulting in apoptosis, decreased intrinsic endothelial vasodilation, and impaired cellular function. All these mechanisms have the common effect of an increased oxidative stress state (Table 1) [10]. Patients with pre-existing hypertension have an increased risk of developing Type 2 diabetes due to vascular hypertrophy, increased fat deposition in skeletal muscle, and decreased receptor responsiveness This leads to decreased delivery of insulin and glucose to the muscle and insulin resistance [24]. Diabetics with hypertension require tighter control of blood pressure as indicated by the UK Prospective Diabetes Study Group in which patients with a BP goal of
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