Diabetic heart disease: The clinical and pathological spectrum—Part I

Abstract

Summary: Diabetes mellitus is a significant condition affecting major segments of all population groups studied. With the introduction of insulin and oral hypoglycemic therapy, and with better understanding of diet and weight control over the past half century, the primary causes of diabetic morbidity and mortality have shifted in varying proportions from metabolic derangements, infection, and renal insufficiency to different types of cardiovascular disease. Despite extensive clinical and laboratory research on the etiology, pathogenesis, and even the existence of cardiovascular disease associated with diabetes mellitus, however, considerable debate is still apparent in this field. Our purpose is to present an overview of the subject of diabetic heart disease, with a critical analysis of epidemiologic, clinical, and pathological data. Some of this material will be addressed from the perspective of research in this area over the past decade by one of us (SMF), particularly in experimental hypertensive and diabetic cardiomyopathy. However, overall, an attempt will be made to provide an objective and balanced analysis, in order to answer the question: does diabetic heart disease exist?Key words: diabetes mellitus, cardiomyopathy , hypertension, epidemiology, pathology EpidemiologyAmple epidemiologic evidence has demonstrated increased morbidity and mortality from heart disease in diabetic patients, much of these data emanating from Framingham. The incidence of coronary heart disease (CHD), cerebrovascular disease, and intermittent claudication was higher in diabetic patients compared to agematched cohorts. Mortality from cardiovascular causes was 4.5 times greater in diabetic women and two times greater in diabetic men. CHD accounted for the greatest number of deaths. The increased risk found in diabetic patients remained after multivariate analysis took into consideration the increased blood pressure and pre-beta lipoprotein levels in diabetic men and women, the higher mean serum cholesterol of diabetic women, and the effects of weight, cigarette smoking, and electmcardiographic evidence of left ventricular hypertrophy.'Framingham data also revealed that coronary heart disease was the greatest cardiovascular risk, with diabetic men having more than a 50% increased incidence, and diabetic women having twice the incidence of CHD events compared with their nondiabetic cohort.2 The incidence of coronary heart disease in patients aged 45 to 75 is greater in diabetic women than in nondiabetic men-a reversal of the expected pattern where the CHD risk is greater in general for men than for women. An especially high risk was noted in diabetic women with superimposed obesity and low high-density lipoprotein cholesterol levels.Congestive heart failure is twice as common in diabetic men and five times more common in diabetic women in the age range 45-74 compared with age-matched controls. This increased risk was found only in those taking insulin for glucose control. The excessive risk remained, and was found to be independe...

Diabetic cardiomyopathy: fact or fiction?

“…It is well established that patients with diabetes mellitus develop coronary artery disease at a younger age, have more multivessel disease, and tend to have more severe, though not more diffuse, coronary artery disease 9. Microangiopathic changes in the small vessels of the heart of diabetic patients may contribute to diabetic cardiomyopathy 10.…”

Effects of restoring normoglycemia in type 1 diabetes on inflammatory profile and renal extracellular matrix structure after simultaneous pancreas and kidney transplantation

“…Patients with type 1 diabetes have increased risk of macrovascular complications such as atherosclerotic cardiovascular diseases including myocardial dysfunction and stroke [1,2], as well as microvascular complications including neuropathy, retinopathy and nephropathy [3]. Diabetic nephropathy is characterized by hypertension, albuminuria, reduced glomerular filtration rate (GFR) and kidney morphological changes [4].…”

Miocardiopatía diabética: concepto, función cardiaca y patogenia

“…En los estudios anteriormente citados, la presencia de NAC se ha objetivado mediante los tests reflejos cardiovasculares convencionales (tests parasimpáticos y simpáticos) y éstos únicamente reflejan indirectamente el estado del sistema nervioso autonómico, siendo más frecuentemente anormales los tests parasimpáticos que los simpáticos, lo que está en concordancia con el concepto general de que la afectación del sistema nervioso parasimpático precede a la del sistema nervioso simpático (59)(60)(61). Nosotros, utilizanto estos tests, encontramos alteración del test parasimpático en un 22% de los pacientes estudiados, siendo el test simpático normal en todos los enfermos (30).…”