1. Improving the adverse cardiovascular prognosis of type 2 diabetes.
- Author
-
O'Keefe JH Jr, Miles JM, Harris WH, Moe RM, and McCallister BD
- Subjects
- Antihypertensive Agents therapeutic use, Cardiovascular Diseases physiopathology, Diabetes Mellitus, Type 2 drug therapy, Diabetes Mellitus, Type 2 physiopathology, Humans, Hyperlipidemias etiology, Hyperlipidemias physiopathology, Hypertension etiology, Hypertension physiopathology, Hypoglycemic Agents therapeutic use, Insulin Resistance, Life Style, Myocardial Infarction etiology, Myocardial Infarction physiopathology, Myocardial Infarction therapy, Myocardial Revascularization, Prognosis, Cardiovascular Diseases etiology, Cardiovascular Diseases prevention & control, Diabetes Mellitus, Type 2 complications, Diabetes Mellitus, Type 2 therapy
- Abstract
Approximately 80% of all patients with diabetes die of cardiovascular disease. The traditional management of type 2 diabetes has been ineffective in altering this dismal prognosis. Insulin resistance is the fundamental defect of type 2 diabetes. Insulin resistance often leads to hyperinsulinemia, which is associated with hypertension, atherogenic dyslipidemia, left ventricular hypertrophy, impaired fibrinolysis, visceral obesity, and sedentary lifestyle. Although all these conditions are associated with atherosclerosis and adverse cardiovascular events, the therapeutic efforts in patients with diabetes have focused predominantly on normalizing glucose levels. Improved insulin sensitivity through lifestyle modifications or pharmacologic therapy (troglitazone and metformin) will lower both insulin and glucose levels as well as diminish dyslipidemia and hypertension. In contrast, sulfonylurea agents lower glucose by increasing insulin levels and may increase the risk of cardiovascular events. Therapy including aspirin, lipid agents (for example, statins), angiotensin-converting enzyme inhibitors, beta-adrenergic blockers, postmenopausal estrogen replacement, and vitamin E should be considered for patients with type 2 diabetes. In most patients with diabetes who have multivessel coronary artery disease, coronary artery bypass grafting is superior to coronary angioplasty for improving long-term cardiovascular prognosis. This superiority is mediated in part by the use of a left internal mammary graft to the left anterior descending coronary artery. Urgent coronary angioplasty or thrombolytic therapy should be considered for all patients with diabetes who have acute myocardial infarction.
- Published
- 1999
- Full Text
- View/download PDF