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The heart in diabetes
Insights
Diabetes significantly increases heart disease risk and severity, particularly in women. Diabetic patients experience more sudden deaths from myocardial infarction and show impaired heart muscle function, even without coronary artery disease.
Area of Science:
- Cardiology
- Endocrinology
- Diabetology
Background:
- Heart disease is a primary cause of mortality in individuals with diabetes mellitus.
- Diabetic patients exhibit accelerated and more severe coronary disease compared to non-diabetics.
- Women with diabetes lose their premenopausal protection against coronary disease.
Purpose of the Study:
- To investigate the impact of diabetes on myocardial function and coronary disease.
- To explore the role of insulin in myocardial response to ischemia.
- To examine cardiac abnormalities in diabetic subjects across species.
Main Methods:
- Comparative analysis of diabetic and non-diabetic populations.
- Assessment of myocardial histology and composition in carbohydrate intolerance.
- Utilizing echocardiography and radionuclide techniques to evaluate myocardial function.
- Investigating autonomic dysfunction in diabetic individuals.
Main Results:
- Diabetic individuals show increased severity and accelerated development of coronary disease.
- Women with diabetes exhibit a unique vulnerability, losing premenopausal protection.
- Diabetic patients have a higher incidence of sudden death post-myocardial infarction.
- Abnormalities in diastolic ventricular function are present in diabetic subjects, independent of coronary disease.
- Autonomic dysfunction, particularly parasympathetic, is common and linked to poor prognosis.
Conclusions:
- Diabetes mellitus poses a significant threat to cardiovascular health, impacting myocardial function beyond coronary artery disease.
- Early detection and management of cardiac abnormalities and autonomic dysfunction are crucial in diabetic patients.
- Further research with invasive data and larger populations is needed to confirm findings and refine understanding.
Abstract:
Since the introduction of insulin, heart disease has become a major impediment to survival in persons with diabetes mellitus. Coronary disease has increased severity and accelerated development in diabetic persons compared with an age- and sex-matched nondiabetic population. A peculiar vulnerability of women to the influence of diabetes with loss of premenopausal coronary disease protection has been found. The symptomatology of coronary events may differ and coronary care data show a higher incidence of sudden death in diabetic patients who have a myocardial infarction than in their non-diabetic counterparts. Insulin may play a role in the myocardial adjustment to an ischemic insult by enhancing glucose intake and suppressing lipolysis and ketogenesis. Carbohydrate intolerance in dogs, rhesus monkeys and humans appears associated with similar histologic and compositional changes in the myocardium. Abnormalities in diastolic ventricular function not attributable to large- or small-vessel coronary disease have been found in the diabetic subjects of each species. Studies in humans who have diabetes have assessed single pressure-volume relationships and more exacting measures of ventricular compliance are needed. Abnormalities of myocardial function in patients with diabetes have been found using echo and radionuclide techniques. Many of these findings need to be correlated with invasive data or confirmed in larger populations. Autonomic dysfunction is common in diabetic persons and may imply an associated poor prognosis. Reflex abnormalities in parasympathetic function are most prevalent and occur before sympathetic dysfunction.