Abstract
Although diabetes mellitus is predominantly a metabolic disorder, recent data suggest that it is as much a vascular disorder. Cardiovascular complications are the leading cause of death and disability in patients with diabetes mellitus. A number of recent reports have emphasized that many patients already have atherosclerosis in progression by the time they are diagnosed with clinical evidence of diabetes mellitus. The increased risk of atherosclerosis and cardiovascular complications in diabetic patients is related to the frequently associated dyslipidemia, hypertension, hyperglycemia, hyperinsulinemia, and endothelial dysfunction. The evolving knowledge regarding the variety of metabolic, hormonal, and hemodynamic abnormalities in patients with diabetes mellitus has led to efforts designed for early identification of individuals at risk of subsequent disease. It has been suggested that insulin resistance, the key abnormality in type II diabetes, often precedes clinical features of diabetes by 5–6 years. Careful attention to the criteria described for the cardiovascular dysmetabolic syndrome should help identify those at risk at an early stage. The application of nonpharmacologic as well as newer emerging pharmacologic therapies can have beneficial effects in individuals with cardiovascular dysmetabolic syndrome and/or diabetes mellitus by improving insulin sensitivity and related abnormalities. Early identification and implementation of appropriate therapeutic strategies would be necessary to contain the emerging new epidemic of cardiovascular disease related to diabetes.
Highlights
CV complications are the leading cause of death and disability in patients with type II diabetes mellitus (DM) [1]
The magnitude of CV complications in DM is best illustrated by a recent report demonstrating that the risk of myocardial infarction in diabetic patients with no prior myocardial infarction was as high as that in nondiabetic patients with a history of prior myocardial infarction [2]
Several studies have evaluated the role of potential factors that could increase the risk of atherosclerosis in association with DM [7,8,9,10]
Summary
Recent data show that the prevalence of type II diabetes is rapidly increasing in the world. Identification by regular evaluation for CDS in susceptible individuals should help to identify the high-risk individuals who will benefit from aggressive nonpharmacologic as well as pharmacologic measures (when necessary) directed toward decreasing their risk for developing DM and CV disease. The thiazolidinediones, such as pioglitazone or rosiglitazone, reduce insulin resistance in muscle [19] and, to a lesser extent, reduce hepatic glucose production [20]. The thiazolidinediones can decrease blood pressure by reducing peripheral vascular resistance due to improved endothelial function [22] Some of these agents can increase high-density lipoprotein cholesterol and decrease triglyceride levels [22].
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