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  1. Peter J Watkins

    Diabetic patients, particularly those with type 2 diabetes or proteinuria, are at considerable risk of excessive morbidity and mortality from cardiovascular, cerebrovascular, and peripheral vascular disease leading to myocardial infarction, strokes, and amputations. Much effort must be given to reducing the risk factors that predispose to major atheromatous arterial disease. The many available measures add to the complexity of treating diabetic patients, especially those with type 2 diabetes.

    This article is adapted from the 5th edition of the ABC of Diabetes, which is published by BMJ Books (www.bmjbooks.com)

    Factors increasing risk of developing CHD in diabetic patients

    • Smoking

    • Hypertension

    • Insulin resistance associated with obesity

    • Asian origin

    • Microalbuminuria

    • Diabetic nephropathy (macroalbuminuria)

    • Poor glycaemic control

    • Hyperlipidaemia

    Coronary artery disease

    Cardiovascular disease is substantially increased in diabetes, with hyperglycaemia an independent risk factor. It is the chief cause of death, and the focus on reducing the risk factors responsible strongly influences the management of diabetes.

    Rates of serious cardiovascular events according to target diastolic blood pressure in 1500 patients with hypertension and type 2 diabetes

    Diabetes more than doubles the risk of cardiovascular disease. In the United Kingdom, 35% of deaths are due to cardiovascular causes, compared with about 60% in those with type 2 diabetes and 67% of type 1 diabetic patients over 40 years old. Diabetes increases the risk more in women than men, so that the risk of cardiovascular death is equal in both sexes in diabetic patients. The development of myocardial infarction over seven years in middle aged diabetic patients without known pre-existing coronary heart disease (CHD) is the same as that in non-diabetic patients with CHD. The presence of proteinuria and even microalbuminuria increases the risk of CHD and mortality from myocardial infarction.

    Prevention of cardiovascular disease: effects of lowering blood pressure

    Those with a high risk of cardiovascular disease stand to gain proportionately greater benefit from reducing risk factors. Two recent major trials show what can …

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