Macrovascular disease in diabetes

Abstract

<h2>Abstract</h2> Macrovascular disease accounts for more than 70% of deaths in people with diabetes, mostly from myocardial infarction, congestive cardiac failure and stroke. Risk factors for the development of macrovascular disease in diabetes include age, race, cigarette smoking, hypertension, raised cholesterol, HbA1c, and obesity. There is little support for the suggestion that the macrovascular disease of diabetes is histologically or biochemically different from athersclerosis in the non-diabetic individual, but there may be some differences in the extent and distribution of disease. There is evidence that metformin reduces myocardial infarctions when used as first-line treatment in overweight patients with type 2 diabetes. For patients with type 1 diabetes intensive insulin therapy over a period of 6.5 years significantly reduced macrovascular events in the subsequent 10 years. Aggressive treatment of hypertension can reduce microvascular and macrovascular complications of diabetes, and there is a substantial evidence base for the benefit of statins as both primary and secondary prevention in patients with diabetes. Thrombolysis is of proven benefit for diabetic patients with ST segment elevation myocardial infarction, but the role of intensive intravenous insulin in managing hyperglycaemia in diabetic patients following myocardial infarction remains controversial. Evidence from several sources indicates that coronary artery bypass grafting is better at reducing mortality than percutaneous coronary interventions in the diabetic patient with triple vessel disease or left-main stem disease, and for patients with severe congestive cardiac failure diabetes is not an absolute contraindication to cardiac transplantation.