Diabetes mellitus cardiovascular disease: Difference between revisions
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{{Diabetes mellitus }} | {{Diabetes mellitus }} | ||
{{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto: | {{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh13579@gmail.com]; {{CZ}} | ||
==Overview== | ==Overview== | ||
Cardiovascular complications of diabetes include both microvascular disease, such as [[retinopathy]], [[neuropathy]], and [[nephropathy]] and macrovascular disease such as [[coronary artery disease]] and [[stroke]]. | |||
==Cardiovascular Disease== | |||
Chronic elevation of blood glucose level leads to damage of [[blood vessel]]s ([[angiopathy]]). The [[endothelial cell]]s lining the blood vessels take in more glucose than normal, since they don't depend on insulin. They then form more surface [[glycoprotein]]s than normal, and cause the [[basement membrane]] to grow thicker and weaker. In diabetes, the resulting problems are grouped under "[[microvascular disease]]" (due to damage to small blood vessels) and "[[macrovascular disease]]" (due to damage to the [[artery|arteries]]). | Chronic elevation of blood glucose level leads to damage of [[blood vessel]]s ([[angiopathy]]). The [[endothelial cell]]s lining the blood vessels take in more glucose than normal, since they don't depend on insulin. They then form more surface [[glycoprotein]]s than normal, and cause the [[basement membrane]] to grow thicker and weaker. In diabetes, the resulting problems are grouped under "[[microvascular disease]]" (due to damage to small blood vessels) and "[[macrovascular disease]]" (due to damage to the [[artery|arteries]]). | ||
[[Image:Fundus photo showing scatter laser surgery for diabetic retinopathy EDA09.JPG|thumb|Image of [[Fundus (eye)|fundus]] showing scatter [[Laser scalpel|laser surgery]] for [[diabetic retinopathy]]]] | [[Image:Fundus photo showing scatter laser surgery for diabetic retinopathy EDA09.JPG|thumb|Image of [[Fundus (eye)|fundus]] showing scatter [[Laser scalpel|laser surgery]] for [[diabetic retinopathy]]]] | ||
===Microvascular Disease=== | |||
The damage to small blood vessels leads to a [[microangiopathy]], which can cause one or more of the following: | The damage to small blood vessels leads to a [[microangiopathy]], which can cause one or more of the following: | ||
* ''[[Diabetic retinopathy]]'', growth of friable and poor-quality new blood vessels in the [[retina]] as well as [[macular edema]] (swelling of the [[macula]]), which can lead to severe [[vision loss]] or blindness. Retinal damage (from microangiopathy) makes it the most common cause of blindness among non-elderly adults in the US. | * ''[[Diabetic retinopathy]]'', growth of friable and poor-quality new blood vessels in the [[retina]] as well as [[macular edema]] (swelling of the [[macula]]), which can lead to severe [[vision loss]] or blindness. Retinal damage (from microangiopathy) makes it the most common cause of blindness among non-elderly adults in the US. | ||
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* ''[[Diabetic nephropathy]]'', damage to the [[kidney]] which can lead to chronic renal failure, eventually requiring [[dialysis]]. Diabetes mellitus is the most common cause of adult kidney failure worldwide in the developed world. | * ''[[Diabetic nephropathy]]'', damage to the [[kidney]] which can lead to chronic renal failure, eventually requiring [[dialysis]]. Diabetes mellitus is the most common cause of adult kidney failure worldwide in the developed world. | ||
===Macrovascular Disease=== | |||
[[Macrovascular disease]] leads to cardiovascular disease, to which accelerated [[atherosclerosis]] is a contributor: | [[Macrovascular disease]] leads to cardiovascular disease, to which accelerated [[atherosclerosis]] is a contributor: | ||
*[[Coronary artery disease]], leading to [[Angina pectoris|angina]] or [[myocardial infarction]] ("heart attack") | *[[Coronary artery disease]], leading to [[Angina pectoris|angina]] or [[myocardial infarction]] ("heart attack") | ||
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[[Carotid artery stenosis]] does not occur more often in diabetes, and there appears to be a lower prevalence of [[abdominal aortic aneurysm]]. However, diabetes does cause higher morbidity, mortality and operative risks with these conditions.<!-- | [[Carotid artery stenosis]] does not occur more often in diabetes, and there appears to be a lower prevalence of [[abdominal aortic aneurysm]]. However, diabetes does cause higher morbidity, mortality and operative risks with these conditions.<!-- | ||
--><ref>{{cite journal | author = Weiss J, Sumpio B | title = Review of prevalence and outcome of vascular disease in patients with diabetes mellitus. | journal = Eur J Vasc Endovasc Surg | volume = 31 | issue = 2 | pages = 143-50 | year = 2006 | id = PMID 16203161}}</ref> | --><ref>{{cite journal | author = Weiss J, Sumpio B | title = Review of prevalence and outcome of vascular disease in patients with diabetes mellitus. | journal = Eur J Vasc Endovasc Surg | volume = 31 | issue = 2 | pages = 143-50 | year = 2006 | id = PMID 16203161}}</ref> | ||
===Cardiovascular Disease and Gender=== | |||
While population based studies have shown a higher risk of cardiovascular disorders in men , women with diabetes are faced with a higher risk of [[dyslipidemia]] and cardiovascular disorders than men with diabetes. This seems to be irrespective of menopause status. This could be partially explained by a higher fat tissue and a hyperactive [[immune system]] in women with diabetes. | |||
==Treatment== | ==Treatment== | ||
== ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death (DO NOT EDIT) <ref name="pmid16935995">{{cite journal| author=Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M et al.| title=ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. | journal=Circulation | year= 2006 | volume= 114 | issue= 10 | pages= e385-484 | pmid=16935995 | doi=10.1161/CIRCULATIONAHA.106.178233 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16935995}}</ref> == | |||
=== Recommendations for Endocrine Disorders and Diabetes === | |||
{|class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA Guidelines Classification Scheme#Classification of Recommendations|Class I]] | |||
|- | |||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' The management of ventricular arrhythmias secondary to endocrine disorders should address the electrolyte (potassium, magnesium, and calcium) imbalance and the treatment of the underlying endocrinopathy. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | |||
|- | |||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Persistent life-threatening ventricular arrhythmias that develop in patients with endocrine disorders should be treated in the same manner that such arrhythmias are treated in patients with other diseases, including use of ICD and pacemaker implantation as required in those who are receiving chronic optimal medical therapy and who have reasonable expectation of survival with a good functional status for more than 1 y. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | |||
|- | |||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' Patients with diabetes with ventricular arrhythmias should generally be treated in the same manner as patients without diabetes. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki> | |||
|} | |||
===Primary Prevention=== | ===Primary Prevention=== | ||
====ACC/AHA Guidelines- ADA/AHA/ACCF Aspirin for Primary Prevention of Cardiovascular Events in People With Diabetes (DO NOT EDIT)==== | ====ACC/AHA Guidelines- ADA/AHA/ACCF Aspirin for Primary Prevention of Cardiovascular Events in People With Diabetes <ref name="pmid20508178">{{cite journal| author=Pignone M, Alberts MJ, Colwell JA, Cushman M, Inzucchi SE, Mukherjee D et al.| title=Aspirin for primary prevention of cardiovascular events in people with diabetes: a position statement of the American Diabetes Association, a scientific statement of the American Heart Association, and an expert consensus document of the American College of Cardiology Foundation. | journal=Circulation | year= 2010 | volume= 121 | issue= 24 | pages= 2694-701 | pmid=20508178 | doi=10.1161/CIR.0b013e3181e3b133 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20508178 }} </ref> (DO NOT EDIT)==== | ||
{{cquote| | {{cquote| | ||
:# Low-dose (75–162 mg/d) aspirin use for prevention is reasonable for adults with diabetes and no previous history of vascular disease who are at increased CVD risk (10 year risk of CVD events over 10%) and who are not at increased risk for bleeding (based on a history of previous gastrointestinal bleeding or peptic ulcer disease or concurrent use of other medications that increase bleeding risk, such as NSAIDS or warfarin). Those adults with diabetes at increased CVD risk include most men over age 50 years and women over age 60 years who have 1 or more of the following additional major risk factors: smoking, hypertension, dyslipidemia, family history of premature CVD, and albuminuria. (ACCF/AHA Class IIa, Level of Evidence: B) (ADA Level of Evidence: C) | :# Low-dose (75–162 mg/d) aspirin use for prevention is reasonable for adults with diabetes and no previous history of vascular disease who are at increased CVD risk (10 year risk of CVD events over 10%) and who are not at increased risk for bleeding (based on a history of previous gastrointestinal bleeding or peptic ulcer disease or concurrent use of other medications that increase bleeding risk, such as NSAIDS or warfarin). Those adults with diabetes at increased CVD risk include most men over age 50 years and women over age 60 years who have 1 or more of the following additional major risk factors: smoking, hypertension, dyslipidemia, family history of premature CVD, and albuminuria. (ACCF/AHA Class IIa, Level of Evidence: B) (ADA Level of Evidence: C) | ||
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:# Low-dose (75–162 mg/d) aspirin use for prevention might be considered for those with diabetes at intermediate CVD risk (younger patients with 1 or more risk factors, or older patients with no risk factors, or patients with 10-year CVD risk of 5–10%) until further research is available. (ACCF/AHA Class IIb, Level of Evidence: C) (ADA Level of Evidence: E) | :# Low-dose (75–162 mg/d) aspirin use for prevention might be considered for those with diabetes at intermediate CVD risk (younger patients with 1 or more risk factors, or older patients with no risk factors, or patients with 10-year CVD risk of 5–10%) until further research is available. (ACCF/AHA Class IIb, Level of Evidence: C) (ADA Level of Evidence: E) | ||
}} | }} | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
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[[Category:Medical conditions related to obesity]] | [[Category:Medical conditions related to obesity]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Emergency medicine patient information]] | [[Category:Emergency medicine patient information]] | ||
[[Category:Overview complete]] | [[Category:Overview complete]] | ||
[[Category:For review]] | [[Category:For review]] |
Latest revision as of 21:18, 29 July 2020
Diabetes mellitus Main page |
Patient Information |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]; Cafer Zorkun, M.D., Ph.D. [3]
Overview
Cardiovascular complications of diabetes include both microvascular disease, such as retinopathy, neuropathy, and nephropathy and macrovascular disease such as coronary artery disease and stroke.
Cardiovascular Disease
Chronic elevation of blood glucose level leads to damage of blood vessels (angiopathy). The endothelial cells lining the blood vessels take in more glucose than normal, since they don't depend on insulin. They then form more surface glycoproteins than normal, and cause the basement membrane to grow thicker and weaker. In diabetes, the resulting problems are grouped under "microvascular disease" (due to damage to small blood vessels) and "macrovascular disease" (due to damage to the arteries).
Microvascular Disease
The damage to small blood vessels leads to a microangiopathy, which can cause one or more of the following:
- Diabetic retinopathy, growth of friable and poor-quality new blood vessels in the retina as well as macular edema (swelling of the macula), which can lead to severe vision loss or blindness. Retinal damage (from microangiopathy) makes it the most common cause of blindness among non-elderly adults in the US.
- Diabetic neuropathy, abnormal and decreased sensation, usually in a 'glove and stocking' distribution starting with the feet but potentially in other nerves, later often fingers and hands. When combined with damaged blood vessels this can lead to diabetic foot (see below). Other forms of diabetic neuropathy may present as mononeuritis or autonomic neuropathy. Diabetic amyotrophy is muscle weakness due to neuropathy.
- Diabetic nephropathy, damage to the kidney which can lead to chronic renal failure, eventually requiring dialysis. Diabetes mellitus is the most common cause of adult kidney failure worldwide in the developed world.
Macrovascular Disease
Macrovascular disease leads to cardiovascular disease, to which accelerated atherosclerosis is a contributor:
- Coronary artery disease, leading to angina or myocardial infarction ("heart attack")
- Stroke (mainly the ischemic type)
- Peripheral vascular disease, which contributes to intermittent claudication (exertion-related leg and foot pain) as well as diabetic foot.
- Diabetic myonecrosis ('muscle wasting')
Diabetic foot, often due to a combination of neuropathy and arterial disease, may cause skin ulcer and infection and, in serious cases, necrosis and gangrene. It is why diabetics are prone to leg and foot infections and why it takes longer for them to heal from leg and foot wounds. It is the most common cause of adult amputation, usually of toes and or feet, in the developed world.
Carotid artery stenosis does not occur more often in diabetes, and there appears to be a lower prevalence of abdominal aortic aneurysm. However, diabetes does cause higher morbidity, mortality and operative risks with these conditions.[1]
Cardiovascular Disease and Gender
While population based studies have shown a higher risk of cardiovascular disorders in men , women with diabetes are faced with a higher risk of dyslipidemia and cardiovascular disorders than men with diabetes. This seems to be irrespective of menopause status. This could be partially explained by a higher fat tissue and a hyperactive immune system in women with diabetes.
Treatment
ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death (DO NOT EDIT) [2]
Recommendations for Endocrine Disorders and Diabetes
Class I |
"1. The management of ventricular arrhythmias secondary to endocrine disorders should address the electrolyte (potassium, magnesium, and calcium) imbalance and the treatment of the underlying endocrinopathy. (Level of Evidence: C)" |
"2. Persistent life-threatening ventricular arrhythmias that develop in patients with endocrine disorders should be treated in the same manner that such arrhythmias are treated in patients with other diseases, including use of ICD and pacemaker implantation as required in those who are receiving chronic optimal medical therapy and who have reasonable expectation of survival with a good functional status for more than 1 y. (Level of Evidence: C)" |
"3. Patients with diabetes with ventricular arrhythmias should generally be treated in the same manner as patients without diabetes. (Level of Evidence: A)" |
Primary Prevention
ACC/AHA Guidelines- ADA/AHA/ACCF Aspirin for Primary Prevention of Cardiovascular Events in People With Diabetes [3] (DO NOT EDIT)
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References
- ↑ Weiss J, Sumpio B (2006). "Review of prevalence and outcome of vascular disease in patients with diabetes mellitus". Eur J Vasc Endovasc Surg. 31 (2): 143–50. PMID 16203161.
- ↑ Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M; et al. (2006). "ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society". Circulation. 114 (10): e385–484. doi:10.1161/CIRCULATIONAHA.106.178233. PMID 16935995.
- ↑ Pignone M, Alberts MJ, Colwell JA, Cushman M, Inzucchi SE, Mukherjee D; et al. (2010). "Aspirin for primary prevention of cardiovascular events in people with diabetes: a position statement of the American Diabetes Association, a scientific statement of the American Heart Association, and an expert consensus document of the American College of Cardiology Foundation". Circulation. 121 (24): 2694–701. doi:10.1161/CIR.0b013e3181e3b133. PMID 20508178.