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(Circulation. 1999;100:1134-1146.)
© 1999 American Heart Association, Inc.
AHA Scientific Statement |
Diabetes and Cardiovascular Disease
A Statement for Healthcare Professionals From the American Heart Association
Key Words: AHA Scientific Statements • diabetes mellitus • risk factors • cardiovascular diseases
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Introduction |
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This statement examines the cardiovascular complications of diabetes mellitus and considers opportunities for their prevention. These complications include coronary heart disease (CHD), stroke, peripheral arterial disease, nephropathy, retinopathy, and possibly neuropathy and cardiomyopathy. Because of the aging of the population and an increasing prevalence of obesity and sedentary life habits in the United States, the prevalence of diabetes is increasing. Thus, diabetes must take its place alongside the other major risk factors as important causes of cardiovascular disease (CVD). In fact, from the point of view of cardiovascular medicine, it may be appropriate to say, "diabetes is a cardiovascular disease."
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Clinical Presentations of Diabetes Mellitus |
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The most prevalent form of diabetes mellitus is type 2 diabetes. This disorder typically makes its appearance later in life. The underlying metabolic causes of type 2 diabetes are the combination of impairment in insulin-mediated glucose disposal (insulin resistance) and defective secretion of insulin by pancreatic ß-cells. Insulin resistance develops from obesity and physical inactivity, acting on a substrate of genetic susceptibility.1 2 Insulin secretion declines with advancing age,3 4 and this decline may be accelerated by genetic factors.5 6 Insulin resistance typically precedes the onset of type 2 diabetes and is commonly accompanied by other cardiovascular risk factors: dyslipidemia, hypertension, and prothrombotic factors.7 8 The common clustering of these risk factors in a single individual has been called the metabolic syndrome. Many patients with the metabolic syndrome manifest impaired fasting glucose (IFG)9 even when they do not have overt diabetes mellitus.10 The metabolic syndrome commonly precedes the development of type 2 diabetes by
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W. N. Kernan, C. M. Viscoli, S. E. Inzucchi, L. M. Brass, D. M. Bravata, G. I. Shulman, and J. C. McVeety Prevalence of Abnormal Glucose Tolerance Following a Transient Ischemic Attack or Ischemic Stroke Arch Intern Med, January 24, 2005; 165(2): 227 - 233. [Abstract] [Full Text] [PDF]
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A. Tajaddini, D. L. Kilpatrick, P. Schoenhagen, E. M. Tuzcu, M. Lieber, and D. G. Vince Impact of age and hyperglycemia on the mechanical behavior of intact human coronary arteries: an ex vivo intravascular ultrasound study Am J Physiol Heart Circ Physiol, January 1, 2005; 288(1): H250 - H255. [Abstract] [Full Text] [PDF]
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M. Tsuchiya, E. Suzuki, K. Egawa, Y. Nishio, H. Maegawa, S. Inoue, K. Mitsunami, S. Morikawa, T. Inubushi, and A. Kashiwagi Stiffness and Impaired Blood Flow in Lower-Leg Arteries Are Associated With Severity of Coronary Artery Calcification Among Asymptomatic Type 2 Diabetic Patients Diabetes Care, October 1, 2004; 27(10): 2409 - 2415. [Abstract] [Full Text] [PDF]
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J. R. Sowers Treatment of Hypertension in Patients With Diabetes Arch Intern Med, September 27, 2004; 164(17): 1850 - 1857. [Abstract] [Full Text] [PDF]
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G. Vrentzos, J. A. Papadakis, N. Malliaraki, E. A. Zacharis, K. Katsogridakis, A. N. Margioris, P. E. Vardas, and E. S. Ganotakis Association of Serum Total Homocysteine with the Extent of Ischemic Heart Disease in a Mediterranean Cohort Angiology, September 1, 2004; 55(5): 517 - 524. [Abstract] [PDF]
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N. F. Sheard, N. G. Clark, J. C. Brand-Miller, M. J. Franz, F. X. Pi-Sunyer, E. Mayer-Davis, K. Kulkarni, and P. Geil Dietary Carbohydrate (Amount and Type) in the Prevention and Management of Diabetes: A statement by the American Diabetes Association Diabetes Care, September 1, 2004; 27(9): 2266 - 2271. [Full Text] [PDF]
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Task Force Members, J. Lopez-Sendo, K. Swedberg, J. McMurray, J. Tamargo, A. P. Maggioni, H. Dargie, M. Tendera, F. Waagstein, J. Kjekshus, et al. Expert consensus document on {beta}-adrenergic receptor blockers: The Task Force on Beta-Blockers of the European Society of Cardiology Eur. Heart J., August 1, 2004; 25(15): 1341 - 1362. [Full Text] [PDF]
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 S. R. Teixeira, K. A. Tappenden, L. Carson, R. Jones, M. Prabhudesai, W. P. Marshall, and J. W. Erdman Jr. Isolated Soy Protein Consumption Reduces Urinary Albumin Excretion and Improves the Serum Lipid Profile in Men with Type 2 Diabetes Mellitus and Nephropathy J. Nutr., August 1, 2004; 134(8): 1874 - 1880. [Abstract] [Full Text] [PDF]
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J. F. LaDisa Jr., J. G. Krolikowski, P. S. Pagel, D. C. Warltier, and J. R. Kersten Cardioprotection by glucose-insulin-potassium: dependence on KATP channel opening and blood glucose concentration before ischemia Am J Physiol Heart Circ Physiol, August 1, 2004; 287(2): H601 - H607. [Abstract] [Full Text] [PDF]
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O. Vaccaro, L. E. Eberly, J. D. Neaton, L. Yang, G. Riccardi, J. Stamler, and for the Multiple Risk Factor Intervention Trial R Impact of Diabetes and Previous Myocardial Infarction on Long-term Survival: 25-Year Mortality Follow-up of Primary Screenees of the Multiple Risk Factor Intervention Trial Arch Intern Med, July 12, 2004; 164(13): 1438 - 1443. [Abstract] [Full Text] [PDF]
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V. Franco, S. Oparil, and O. A. Carretero Hypertensive Therapy: Part II Circulation, June 29, 2004; 109(25): 3081 - 3088. [Full Text] [PDF]
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D. Weihrauch, N. L. Lohr, B. Mraovic, L. M. Ludwig, W. M. Chilian, P. S. Pagel, D. C. Warltier, and J. R. Kersten Chronic Hyperglycemia Attenuates Coronary Collateral Development and Impairs Proliferative Properties of Myocardial Interstitial Fluid by Production of Angiostatin Circulation, May 18, 2004; 109(19): 2343 - 2348. [Abstract] [Full Text] [PDF]
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A. Tenenbaum, M. Motro, E. Z. Fisman, E. Schwammenthal, Y. Adler, I. Goldenberg, J. Leor, V. Boyko, L. Mandelzweig, and S. Behar Peroxisome Proliferator-Activated Receptor Ligand Bezafibrate for Prevention of Type 2 Diabetes Mellitus in Patients With Coronary Artery Disease Circulation, May 11, 2004; 109(18): 2197 - 2202. [Abstract] [Full Text] [PDF]
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P. Raggi, L. J. Shaw, D. S. Berman, and T. Q. Callister Prognostic value of coronary artery calcium screening in subjects with and without diabetes J. Am. Coll. Cardiol., May 5, 2004; 43(9): 1663 - 1669. [Abstract] [Full Text] [PDF]
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 J. A. Morgan, R. John, A. D. Weinberg, N. J. Colletti, D. M. Mancini, and N. M. Edwards Heart transplantation in diabetic recipients: A decade review of 161 patients at Columbia Presbyterian J. Thorac. Cardiovasc. Surg., May 1, 2004; 127(5): 1486 - 1492. [Abstract] [Full Text] [PDF]
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S. R. Wilson, B. A. Vakili, W. Sherman, T. A. Sanborn, and D. L. Brown Effect of Diabetes on Long-Term Mortality Following Contemporary Percutaneous Coronary Intervention: Analysis of 4,284 cases Diabetes Care, May 1, 2004; 27(5): 1137 - 1142. [Abstract] [Full Text] [PDF]
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J. A. Cramer A Systematic Review of Adherence With Medications for Diabetes Diabetes Care, May 1, 2004; 27(5): 1218 - 1224. [Abstract] [Full Text] [PDF]
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A. J. Davidoff, M. M. Mason, M. B. Davidson, M. W. Carmody, K. K. Hintz, L. E. Wold, D. A. Podolin, and J. Ren Sucrose-induced cardiomyocyte dysfunction is both preventable and reversible with clinically relevant treatments Am J Physiol Endocrinol Metab, May 1, 2004; 286(5): E718 - E724. [Abstract] [Full Text] [PDF]
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N. L. Smith, L. Chen, D. H. Au, M. McDonell, and S. D. Fihn Cardiovascular Risk Factor Control Among Veterans With Diabetes: The Ambulatory Care Quality Improvement Project Diabetes Care, May 1, 2004; 27(suppl_2): B33 - B38. [Abstract] [Full Text] [PDF]
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M. J Zellweger, R. Hachamovitch, X. Kang, S. W Hayes, J. D Friedman, G. Germano, M. E Pfisterer, and D. S Berman Prognostic relevance of symptoms versus objective evidence of coronary artery disease in diabetic patients Eur. Heart J., April 1, 2004; 25(7): 543 - 550. [Abstract] [Full Text] [PDF]
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 D. Fetterolf and R. West The Business Case for Quality: Combining Medical Literature Research with Health Plan Data to Establish Value for Nonclinical Managers American Journal of Medical Quality, March 1, 2004; 19(2): 48 - 55. [Abstract] [PDF]
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C. A. Witczak and M. Sturek Exercise prevents diabetes-induced impairment in superficial buffer barrier in porcine coronary smooth muscle J Appl Physiol, March 1, 2004; 96(3): 1069 - 1079. [Abstract] [Full Text] [PDF]
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Y. Shimoni, M. Chuang, E. D. Abel, and David. L. Severson Gender-dependent attenuation of cardiac potassium currents in type 2 diabetic db/db mice J. Physiol., March 1, 2004; 555(2): 345 - 354. [Abstract] [Full Text] [PDF]
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C. D. Lee, A. R. Folsom, J. S. Pankow, F. L. Brancati, and For the Atherosclerosis Risk in Communities (ARIC) Cardiovascular Events in Diabetic and Nondiabetic Adults With or Without History of Myocardial Infarction Circulation, February 24, 2004; 109(7): 855 - 860. [Abstract] [Full Text] [PDF]
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A. V. Chobanian, G. L. Bakris, H. R. Black, W. C. Cushman, L. A. Green, J. L. Izzo Jr, D. W. Jones, B. J. Materson, S. Oparil, J. T. Wright Jr, et al. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure Hypertension, December 1, 2003; 42(6): 1206 - 1252. [Abstract] [Full Text] [PDF]
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M.-S. Wong, K. Gu, D. Heng, S.-K. Chew, L.-S. Chew, and E. S. Tai The Singapore Impaired Glucose Tolerance Follow-Up Study: Does the ticking clock go backward as well as forward? Diabetes Care, November 1, 2003; 26(11): 3024 - 3030. [Abstract] [Full Text] [PDF]
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