Diabetes and atherosclerosis: an epidemiologic view.

Area of Science:

• Cardiovascular Science
• Endocrinology
• Metabolic Disorders

Background:

• Diabetes mellitus is linked to atherogenic changes in plasma lipids and lipoproteins.
• Diabetic nephropathy in insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM) is associated with dyslipoproteinemia.
• Hypertension is more frequent in both IDDM and NIDDM, with distinct underlying mechanisms.

Purpose of the Study:

• To investigate the complex relationship between diabetes, dyslipoproteinemia, hypertension, and accelerated atherogenesis.
• To explore the contribution of traditional risk factors versus diabetes-specific mechanisms to cardiovascular risk in diabetic patients.

Main Methods:

• Analysis of plasma lipid and lipoprotein profiles in diabetic and non-diabetic individuals.
• Assessment of hypertension prevalence and its association with disease type and duration.
• Review of hemostatic factors and their potential role in cardiovascular risk.

Main Results:

• NIDDM shows elevated triglycerides and decreased HDL-cholesterol, often unresponsive to glycemic control.
• Hypertension in IDDM is linked to nephropathy, while in NIDDM it's often present at diagnosis.
• Traditional risk factors explain only a portion of the excess cardiovascular risk in diabetics, with unexplained mechanisms contributing significantly.

Conclusions:

• Diabetes-associated dyslipoproteinemia and hypertension are key contributors to enhanced atherogenesis.
• Unexplained mechanisms, beyond traditional risk factors, play a major role in the elevated cardiovascular risk observed in diabetic patients.
• Further research is crucial to elucidate the pathophysiology of accelerated atherosclerosis in diabetes, particularly in female diabetics.