Type 2 diabetes mellitus: a cardiovascular perspective

Abstract

Diabetes mellitus is a disease, which is at the epitome of cardiovascular risk factors causing considerable morbidity and mortality. In addition to microvascular complications, there is two- to six-fold increased risk of macrovascular diseases, such as coronary artery disease, peripheral artery disease and stroke. While the mortality from coronary artery disease in patients without diabetes has declined over the past 20 years, the mortality in men with type 2 diabetes mellitus has not changed. Furthermore, the prevalence of diabetes in the UK has increased by 30% since 1991 and the same among the world population in 2010 is expected to be twice in 1990. This dramatic increase has serious implications from a cardiovascular perspective and thus the aggressive management of blood pressure, dyslipidaemia and blood glucose in diabetes is of vital importance. The aim of this review is to evaluate the current evidence and to discuss the implications of type 2 diabetes and its relevance to clinical practice in cardiology. We address this broad subject in discussing (i) the pathophysiology of cardiovascular disease in the setting of type 2 diabetes and (ii) the prevalence of cardiovascular risk, complications and prognostic implications in type 2 diabetes, with a discussion of current therapeutic interventions for the prevention or delay of these consequences where relevant.

Glycoprotein Ibα Polymorphism T145M, Elevated Lipoprotein-Associated Phospholipase A2, and Hypertriglyceridemia Predict Risk for Recurrent Coronary Events in Diabetic Postinfarction Patients

“…In addition, type 2 diabetic patients with prior MI have higher rates of recurrent MI than patients with prior MI without diabetes (2). Progression of CHD in type 2 diabetic patients is only partially dependent on conventional risk factors (3,4); additional factors include long-term regulation of blood vessel structure and function by the renin-angiotensin-aldosterone system, vascular matrix fibrosis and stiffness associated with abnormalities of extracellular matrix turnover, oxidative stress, chronic low-grade inflammation, endothelial dysfunction, hypercoagulation, decreased fibrinolysis, and platelet hyperactivation (5,6).…”

Glucose increases hepatic lipase expression in HepG2 liver cells through upregulation of upstream stimulatory factors 1 and 2

“…This mechanism may contribute to the development of the dyslipidaemia that is typical of type 2 diabetes. Introduction Morbidity and mortality rates in patients with type 2 diabetes are largely dominated by the occurrence of atherosclerotic cardiovascular disease [1]. The insulin-resistant state that precedes the development of type 2 diabetes is also associated with increased risk of cardiovascular disease [2][3][4].…”

Antihypertensive therapy in diabetes mellitus: insights from ALLHAT and the Blood Pressure-Lowering Treatment Trialists’ Collaboration meta-analysis

“…Blockade of the RAAS (with ACE inhibitors and ARBs) is the treatment of choice in delaying the progression of diabetic nephropathy, with reversal of elevated rates of albumin excretion to normal values with these agents, despite BP reduction being minimal. 31 However, it is uncertain that the reduction of albumin excretion rate is due to a separate renal effect or merely due to a reduction in BP. Therefore, different effect of various BP-lowering regimes on intermediate renal outcomes will offer the rationale for using specific drug classes in patients with DM.…”