Diabetes and cardiovascular disease: Epidemiology, biological mechanisms, treatment recommendations and future research


The incidence of diabetes mellitus (DM) is increasing substantially worldwide. Over the past three decades, the global burden of DM has swelled from 30 million in 1985 to 382 million in 2014, with current trends indicating that these rates will only continue to rise[1]. The latest estimates by the international diabetes federation project that 592 million (1 in 10 persons) worldwide will have DM by 2035[2]. While the rates of both type 1 DM (T1DM) and T2DM are growing, T2DM has a disproportionately greater contribution to the rising prevalence of DM globally compared to T1DM[1]. One consequence of the growing rates of DM is a considerable economic burden both for the patient and the healthcare system. In the United States, the total cost of DM averages $2108/patient per year, which is nearly twice that of non-diabetic patients[3]. The economic burden associated with DM is substantial both in terms of the direct costs of medical care as well as indirect costs of diminished productivity tied to diabetes related morbidity and mortality[4]. The direct costs of DM are primarily attributed to both macrovascular and microvascular complications such as coronary artery disease, myocardial infarction, hypertension, peripheral vascular disease, retinopathy, end-stage renal disease and neuropathy[3,4].

A close link exists between DM and cardiovascular disease (CVD). CVD is the most prevalent cause of mortality and morbidity in diabetic populations[5]. CVD death rates in the United States are 1.7 times higher among adults (> 18 years) with DM than those without diagnosed DM, largely due to an increased risk of stroke and myocardial infarction (MI)[6]. This increased risk of CVD mortality in diabetic patients is found in both men and women. The relative risk for CVD morbidity and mortality in adults with diabetes ranges from 1 to 3 in men and from 2 to 5 in women compared to those those without DM[7].

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Proper control and treatment of DM is critical as both the prevalence and economic burden of the disease continue to mount. As CVD is the most prevalent cause of mortality and morbidity in patients with DM, a primary goal of diabetes treatment should be to improve the cardiovascular (CV) risk of diabetic patients. However, one challenge associated with treating DM and reducing CV events is the complex and multifaceted nature of the relationship linking DM to CVD. CV risk factors including obesity, hypertension and dyslipidemia are common in patients with DM, particularly those with T2DM. In addition, studies have reported that several factors including increased oxidative stress, increased coagulability, endothelial dysfunction and autonomic neuropathy are often present in patients with DM and may directly contribute to the development of CVD[5]. Collectively, the high rates of CV risk factors and direct biological effects of diabetes on the CV system place diabetic patients at increased risk of developing CVD, and contribute to the increased prevalence of MI, revascularization, stroke and CHF[5,8]. Due to the complexity and numerous mechanisms linking DM to CVD, it is crucial to focus treatment to what will have the greatest clinical impact on improving CV outcomes. This paper examines the mechanisms linking DM to CVD as well as current treatment recommendations and future research in diabetes management.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4600176/

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