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Cardiovascular mortality and morbidity in type-2 diabetes mellitus
1Department of Medicine I, Rudolfstiftung, Vienna, Austria.
Insights
Type-2 diabetes significantly increases cardiovascular risks, even without traditional risk factors. Improved diabetes management may be reducing this mortality risk over time.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Prospective studies show significantly increased cardiovascular morbidity and mortality in type-2 diabetes patients compared to non-diabetic individuals.
- Type-2 diabetic patients face a poorer prognosis due to decreased survival post-myocardial infarction and heart failure, alongside increased silent ischemia.
- Hemostatic abnormalities and endothelial dysfunction are identified as key risk factors for coronary events in both diabetic and non-diabetic populations.
Purpose of the Study:
- To summarize the increased cardiovascular risks associated with type-2 diabetes.
- To explore factors contributing to the high prevalence of cardiovascular disease at diagnosis.
- To review evidence on changing mortality trends and the role of glycemic control.
Main Methods:
- Review of prospective studies and recent research findings.
- Analysis of cardiovascular event rates and mortality risks in type-2 diabetic populations.
- Examination of the impact of traditional risk factors, hemostatic abnormalities, endothelial dysfunction, and glycemic control.
Main Results:
- Cardiovascular death rates are substantially elevated in type-2 diabetes, even in the absence of hypertension, hypercholesterolemia, or smoking.
- A high prevalence of cardiovascular disease is observed at diagnosis, potentially due to a long prediabetic period and clustered risk factors.
- Recent studies suggest a potential reduction in mortality risk, possibly linked to improved diabetes prognosis and glycemic control (HbA1c < 6.0%).
Conclusions:
- Type-2 diabetes poses a significant cardiovascular threat, necessitating proactive management.
- Early identification and management of risk factors, including glycemic control, are crucial for improving outcomes.
- Ongoing research, such as the UKPDS, will provide further insights into managing cardiovascular risk in type-2 diabetes.
Abstract:
A representative number of prospective studies clearly indicate that cardiovascular morbidity and mortality is significantly increased in type-2 diabetic patients in comparison with non-diabetic control subjects. The cardiovascular death rate is 4.4 fold increased in those diabetic patients presenting none of the classical risk factors (hypertension, hypercholesterinemia or smoking) compared with age-matched control subjects (MRFIT). A decreased survival rate after myocardial infarction, congestive heart failure and an increased occurrence of silent ischemia are responsible for the poor prognosis of type-2 diabetic patients. Recent studies indicate that haemostatic abnormalities and endothelial dysfunction are important risk factors for coronary events in diabetic as well as in nondiabetic patients. In newly diagnosed type-2 diabetic patients a similar prevalence of myocardial infarction and angina compared to previously known type-2 diabetes was found. The long prediabetic period and clustering of risk factors may be very relevant for the high prevalence of cardiovascular disease already at diagnosis of type-2 diabetes. More recent studies performed in Scotland and Verona demonstrated a mortality risk approximately only 50% higher than in nondiabetic subjects. The reduction in the mortality risk could reflect an improvement in diabetes prognosis from the 1960s to the 1980s. Recent observations in type-2 diabetic patients from Finland indicate that glycemic control is an important predictor for coronary heart disease morbidity and mortality. However incidence of coronary heart disease is only low in those patients presenting with a HbAlc value below 6.0%. More information will be available after analysis of the United Kingdom prospective diabetes study. (UKPDS).