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[Cardiac complications of type 2 diabetes]
1Service de Cardiologie, Hôpital Erasme et Polyclinique du Lothier, U.L.B.
Insights
Diabetic patients face higher cardiovascular disease risks due to accelerated atherosclerosis. Annual cardiac evaluations are recommended, with specific stress tests chosen based on individual risk factors.
Area of Science:
- Cardiology
- Endocrinology
- Diabetology
Context:
- Diabetes mellitus significantly increases cardiovascular disease (CVD) risk.
- Diabetic macroangiopathy accounts for two-thirds of mortality in diabetic patients.
- Accelerated atherosclerosis in diabetics leads to more severe and diffuse coronary lesions.
Purpose:
- To highlight the elevated cardiovascular risks in diabetic patients.
- To emphasize the need for regular cardiac risk factor evaluation in diabetes management.
- To provide guidance on appropriate cardiac testing strategies for diabetic individuals.
Summary:
- Diabetes is an independent risk factor for CVD, characterized by accelerated atherosclerosis and more severe coronary lesions compared to non-diabetics.
- Diabetic patients exhibit increased risks of acute pulmonary edema, ventricular dysfunction, and heart failure, often linked to painless ischemia.
- Over 50% of type 2 diabetes diagnoses reveal pre-existing coronary heart disease, underscoring the silent progression of the disease.
Impact:
- Annual screening for CVD risk factors is crucial for all diabetic patients.
- The choice of cardiac testing—standard exercise tests versus stress echocardiography or myocardial perfusion imaging—depends on patient risk stratification.
- Early detection and management of cardiac complications can improve outcomes for individuals with diabetes.
Abstract:
Diabetic patients have a higher prevalence of hypertension, dyslipidemia and obesity. However, diabetes is by itself a major independent risk factor for cardiovascular disease. About two-thirds of total mortality are due to diabetic macroangiopathy. It is characterised by accelerated atherosclerosis, with more severe, more extensive and more diffuse lesions, as compared with nondiabetic patients. Patients with diabetes present more frequently acute pulmonary oedema despite similar infarct sizes than do nondiabetic patients. They are more frequently at risk for ventricular dysfunction, for ventricular aneurysm and for congestive heart failure. At the time of diagnosis of type 2 diabetes, more than 50% of patients have pre-existing coronary heart disease, probably related to painless ischemia, caused by an autonomic denervation of the heart in diabetic patients. International recommendations suggest that all diabetic patients should be evaluated at least annually for the development or progression of risk factors that would prompt cardiac testing. The standard bicycle exercise test should be chosen in an asymptomatic patient with only one other risk factor and with a normal resting ECG. For all other diabetic patients, stress echocardiography or stress myocardial perfusion imaging should be preferably chosen.