Current Atherosclerosis Reports

, Volume 2, Issue 6, pp 476–481 | Cite as

Diabetes and cardiovascular disease

  • Barbara V. Howard
  • Michelle F. Magee


Cardiovascular disease (CVD) is the most frequent and costly complication of type 2 diabetes. In this review, we examine the impact of diabetes on CVD. Shedding some light on the diabetes/CVD relationship are epidemiologic studies, which focused on Native Americans, who collectively experienced little or no diabetes or CVD in the past, but experience both conditions in epidemic proportions today. Almost half of the Native Americans studied had diabetes at baseline. When CVD events were stratified by diabetic status, the relative CVD risk among diabetic men was twice that of nondiabetic men, and the risk among diabetic women was threefold that of nondiabetic women. Among all CVD events, diabetes accounted for 56% in men and 78% in women; most CVD deaths occurred in those with diabetes. Recent attention has focused on defining the relative strength of CVD risk factors in diabetic populations. In many populations, low-density lipoprotein (LDL) cholesterol is lower in diabetic individuals. However, in American Indians, every 10-mg/dL increase in LDL cholesterol has been associated with a 12% increase in CVD risk and every 10-mg/dL decrease in high-density lipoprotein (HDL) cholesterol was associated with an 8% increase in CVD risk. Albuminuria is an important predictor of CVD in diabetic populations. Those with macroalbuminuria had a CVD risk that was four to five times that of diabetic individuals without albuminuria. Other CVD risk factors in diabetes that have come under recent scrutiny in other populations are increased levels of fibrinogin, and C-reactive protein, and leukocytosis. Angiogenic response may be lower in diabetic individuals, and the possible role of infection is being examined in diabetic patients. LDL cholesterol and albuminuria should be the targets of preventive strategies, and promising new areas such as cytokines, growth factor, and the role of infection should be further explored.


Coronary Heart Disease Diabetic Woman Diabetic Individual Indian Health Service Multiple Risk Factor Intervention Trial 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Diabetes in America, edn 2. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, National Diabetes Data Group; 1995.Google Scholar
  2. 2.
    Howard BV, Magee MF: Macrovascular complications of diabetes mellitus. In Diabetes Mellitus, edn 2. Edited by LeRoith D, Taylor SI, Olefsky JM. Philadelphia: Lippincott-Raven, 2000:957–962.Google Scholar
  3. 3.
    Haffner SM, Lehto S, Ronnemaa T, et al.: Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998, 339:229–234.PubMedCrossRefGoogle Scholar
  4. 4.
    Sievers ML, Fisher JR: Diseases of North American Indians. In Biocultural Aspects of Disease. Edited by Rothschild HR. New York: Academic Press; 1981:191–252.Google Scholar
  5. 5.
    Howard BV, Lee ET, Cowan LD, et al.: Coronary heart disease prevalence and its relation to risk factors in American Indians: the Strong Heart Study. Am J Epidemiol 1995, 142:254–268.PubMedGoogle Scholar
  6. 6.
    Indian Health Service: IHS Chart Series Book, June 1984. Washington DC, U.S. Government Printing Office, US Dept. of Health & Human Services; 1984.Google Scholar
  7. 7.
    US Congress: Office of Technology Assessment. Indian Health Care. OTA-H-290. Washington, DC: US Government Printing Office; April, 1986.Google Scholar
  8. 8.
    Lee ET, Cowan LD, Welty TK, et al.: All-cause mortality and cardiovascular disease mortality in three American Indian populations, aged 45–74 years, 1984–1988: The Strong Heart Study. Am J Epidemiol, 1998, 147:995–1008.PubMedGoogle Scholar
  9. 9.
    Howard BV, Lee ET, Cowan LD, et al.: Rising tide of cardiovascular disease in American Indians: the Strong Heart study. Circulation 1999, 99:2389–2395.PubMedGoogle Scholar
  10. 10.
    Chambless LE, Heiss G, Folsom AR, et al.: Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) study, 1987 to 1993. Am J Epidemiol 1997, 146:483–494.PubMedGoogle Scholar
  11. 11.
    Howard BV, Cowan LD, Go O, et al.: Adverse effects of diabetes on multiple cardiovascular disease risk factors in women. Diabetes Care 1998, 21:1258–1265.PubMedCrossRefGoogle Scholar
  12. 12.
    Howard BV, Lee ET, Cowan LD, et al.: LDL cholesterol is a strong predictor of coronary heart disease in diabetic individuals with insulin resistance and low LDL: the Strong Heart study. Atheroscler Thromb Vasc Biol 2000, 20:830–835.Google Scholar
  13. 13.
    Stamler J, Vaccaro O, Neaton JD, Wentworth D: Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care 1993, 16:434–444.PubMedCrossRefGoogle Scholar
  14. 14.
    Haffner SM, Cassells HB: Type 2 diabetes and coronary heart disease. Role of dyslipidemia and insulin resistance. Practical Diabetology 1998:6–9.Google Scholar
  15. 15.
    Goldberg RB: Cardiovascular disease in diabetic patients. Med Clin North Am 2000, 34:81–93.CrossRefGoogle Scholar
  16. 16.
    Borch-Johnsen K, Kreiner S: Proteinuria: value as predictor of cardiovascular mortality in insulin-dependent diabetes mellitus. BMJ 1987, 294:1651–1654.PubMedCrossRefGoogle Scholar
  17. 17.
    Parving HH, Gall MA, Neilson FS: Dyslipidaemia and cardiovascular disease in non-insulin-dependent diabetic patients with and without diabetic nephropathy. J Intern Med 1994, 736:89–94.Google Scholar
  18. 18.
    Savage S, Estacio RO, Jeffers B, Schrier RW: Urinary albumin excretion as a predictor of diabetic retinopathy, neuropathy, and cardiovascular disease in NIDDM. Diabetes Care 1996, 19:1243–1248.PubMedCrossRefGoogle Scholar
  19. 19.
    Rahmaniyan M, Robbins DC, Roman MJ: Albuminuria (UA) is independently associated with larger left ventricular (LV) mass in NIDDM: the Strong Heart Study (SHS). Diabetes 1998, 47:A9.Google Scholar
  20. 20.
    Lydakis C, Lip GY: Microalbuminuria and cardiovascular risk. QJM 1998, 91:381–391.PubMedCrossRefGoogle Scholar
  21. 21.
    McCarty MF: Interleukin-6 as a central mediator of cardiovascular risk associated with chronic inflammation, smoking, diabetes, and visceral obesity: down-regulation with essential fatty acids, ethanol and pentoxifylline. Med Hypotheses 1999, 52:465–477.PubMedCrossRefGoogle Scholar
  22. 22.
    Duh E, Aiello LP: Vascular endothelial growth factor and diabetes: The agonist versus antagonist paradox. Diabetes 1999, 48:1899–1906.PubMedCrossRefGoogle Scholar
  23. 23.
    de Luis DA, Lahera M, Canton R, et al.: Association of Helicobacter pylori infection with cardiovascular and cerebrovascular disease in diabetic patients. Diabetes Care 1998, 21:1129–1132.PubMedCrossRefGoogle Scholar
  24. 24.
    Kenny SJ, Aubert RF, Geiss LS: Prevalence and incidence of non-insulin-dependent diabetes. In Diabetes in America, edn 2. Edited by Harris MI, Cowie CC, Stern MP, et al. Washington, DC: US Government Printing Office; 1995:47–68 (NIH Publ. No. 95-1468).Google Scholar
  25. 25.
    Harris MI, Hadden WC, Knowler WC, Bennett PH: Prevalence of diabetes and impaired glucose tolerance and plasma glucose levels in U.S. population aged 20–74 yr. Diabetes 1987, 36:523–534.PubMedCrossRefGoogle Scholar
  26. 26.
    Kannel WB, McGee DL: Diabetes and glucose tolerance as risk factors for cardiovascular disease: the Framingham study. Diabetes Care 1979, 2:120–126.PubMedCrossRefGoogle Scholar
  27. 27.
    Kannel WB, Wilson PWF: Risk factors that attenuate the female coronary disease advantage. Arch Intern Med 1995, 155:57–61.PubMedCrossRefGoogle Scholar
  28. 28.
    Heyden S, Heiss G, Bartel AG, Hames CG: Sex differences in coronary mortality among diabetics in Evans County, Georgia. J Chron Dis 1980, 33:265–273.PubMedCrossRefGoogle Scholar
  29. 29.
    Pan WH, Cedres LB, Liu K, et al.: Relationship of clinical diabetes and asymptomatic hyperglycemia to risk of coronary heart disease mortality in men and women. Am J Epidemiol 1986, 123:504–516.PubMedGoogle Scholar
  30. 30.
    Elveback LR, Connolly DC, Melton LJ: Coronary heart disease in residents of Rochester, Minnesota: incidence, 1950 through 1982. Mayo Clin Proc 1986, 61:896–900.PubMedGoogle Scholar
  31. 31.
    DeStefano F, Ford ES, Newman J, et al.: Risk factors of coronary heart disease mortality among persons with diabetes. Ann Epidemiol 1993, 3:27–34.PubMedCrossRefGoogle Scholar
  32. 32.
    Sprafka JM, Pankow J, McGovern PG, French LR: Mortality among type 2 diabetic individuals and associated risk factors: the Three City study. Diabet Med 1993, 10:627–632.PubMedGoogle Scholar
  33. 33.
    Barrett-Connor EL, Cohn BA, Wingard DL, Edelstein SL: Why is diabetes mellitus a stronger risk factor for fatal ischemic heart disease in women than in men? the Rancho Bernardo study. JAMA 1991, 265:627–631.PubMedCrossRefGoogle Scholar
  34. 34.
    Rewers M, Shetterly SM, Baxter J, et al.: Prevalence of coronary heart disease in subjects with normal and impaired glucose tolerance and non-insulin-dependent diabetes mellitus in a biethnic Colorado population: the San Luis Valley Diabetes study. Am J Epidemiol 1992, 135:1321–1330.PubMedGoogle Scholar
  35. 35.
    Matthews KA, Meilahn E, Kuller LH, et al.: Menopause and risk factors for coronary heart disease. N Engl J Med 1989, 321:641–646.PubMedCrossRefGoogle Scholar
  36. 36.
    Wahl PW, Walden CE, Knopp RH, et al.: Lipid and lipoprotein triglyceride and cholesterol interrelationships: effects of sex, hormone use, and hyperlipidemia. Metabolism 1984, 33:502–508.PubMedCrossRefGoogle Scholar
  37. 37.
    Knopp RH, Zhu X, Bonet B: Effects of estrogens on lipoprotein metabolism and cardiovascular disease in women. Atherosclerosis 1995, 110:S83-S91.CrossRefGoogle Scholar
  38. 38.
    Peiris AN, Aiman EJ, Drucker WD, Kissebah AH: The relative contributions of hepatic and peripheral tissue to insulin resistance in hyperandrogenic women. J Clin Endocrin Metab 1989, 68:715–720.CrossRefGoogle Scholar

Copyright information

© Current Science Inc 2000

Authors and Affiliations

  • Barbara V. Howard
    • 1
  • Michelle F. Magee
    • 1
  1. 1.MedStar Research InstituteWashington, DCUSA

Personalised recommendations