Diabetes, Cardiovascular Risk and Nephropathy
Section snippets
High Prevalence of CVD in Diabetes
Individuals with diabetes have high rates of CVD. Cohorts from the Framingham Heart Study who were at least 50 years old and had no evidence of CVD at baseline were followed to assess their lifetime risk of developing CVD. Increased cholesterol and blood pressure were associated with increased risk of CVD. Diabetes represented the largest single risk factor, with 57.3% of women and 67.1% of men with diabetes developing CVD compared with 16.3% and 30.2% of age-matched women and men without
Risk factors for CVD in diabetes
As noted, individuals with diabetes have high rates of CVD. This can be partly explained by the high prevalence of coexisting diseases such as nephropathy, dyslipidemias, hypertension, and obesity. This article provides a brief summary (see the articles by Polonsky and Locatelli, Hopkins and Bakris, Saha and Tuttle, and Sorrentino elsewhere in this issue for further exploration of these topics).
CVD and glucose increases
The incidence of complications related to diabetes increases with higher levels of hyperglycemia, and this relationship is also noted with CVD. In a meta-analysis of observational studies of the relationship between hemoglobin A1c (HbA1c) and CVD, an 18% increased risk of CVD was seen for every 1% increase in HbA1c.44 In the Heart Outcome Prevention Evaluation (HOPE) study, a 1% increase in HbA1c was linked to higher rates of nephropathy (rate ratio [RR] 1.34, P<.0001), CV events (RR 1.07, P =
Type 1 Diabetes
There have been multiple interventional studies of the association between tight glycemic control and CVD. The Diabetes Control and Complications Trial (DCCT) was a multicenter, randomized, clinical trial of 1441 subjects with type 1 diabetes that compared the effects of intensive diabetes treatment with conventional diabetes treatment on the development and progression of the long-term complications of type 1 diabetes. Subjects were followed for a mean of 6.5 years. At baseline, mean
Summary
Diabetic patients with CKD are at extraordinarily high risk for CVD, and the greater the amount of CKD, the greater the risk. Therefore, all aspects of risk reduction should be rigorously applied to such patients. Statins should be used with reduction of LDL cholesterol levels to less than 70 mg/dL in all such patients. Although no benefit of such reduction has been shown in patients with diabetes on dialysis, it is not known whether statins should be withdrawn when patients start on dialysis.
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Effects of high-dose parenteral vitamin D therapy on lipid profile and blood pressure in patients with diabetic nephropathy: A randomized double-blind clinical trial
2017, Diabetes and Metabolic Syndrome: Clinical Research and ReviewsCitation Excerpt :Diabetic nephropathy is a leading cause of end stage renal disease worldwide [1] and the onset of nephropathy amplifies the already existent risk of cardiovascular disease (CVD) in diabetes [2]. Several metabolic derangements that accompany renal dysfunction in diabetes such as worsening of insulin resistance, albuminuria, high blood pressure, alteration of plasma lipids probably underlie this increased predilection [3]. Therapeutic interventions aimed at reducing blood pressure, controlling albuminuria and optimizing plasma lipids, however, have not significantly reduced cardiovascular morbidity and mortality in patients with diabetic nephropathy [4].
Hypercoagulability and cardiovascular disease in diabetic nephropathy
2013, Clinica Chimica ActaCitation Excerpt :Therefore, it is not completely clear how the kinetics of these two events is connected and which one precedes each other. The association between diabetic nephropathy and increased risk for the development of atherosclerotic disease is well known [52]. Kim et al. [53] evaluated the presence of atherosclerosis in coronary and aorta arteries in type 1 diabetic patients with and without diabetic nephropathy using cardiovascular magnetic resonance imaging, and found a higher prevalence of atherosclerosis in coronary arteries of diabetic patients with nephropathy than in those without nephropathy.
Association of high blood lead level and diabetic retinopathy among Saudi diabetic patients
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