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Cardiac Surgery and Diabetes Mellitus

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Diabetes and Cardiovascular Disease

Part of the book series: Contemporary Cardiology ((CONCARD))

Abstract

In 2018, 34.2 million or 10.5% of the US population were affected by diabetes, and 88 million Americans aged 18 and older had prediabetes [1]. These individuals carry up to eight times the risk of cardiovascular events compared to nondiabetic individuals, making cardiovascular disease the largest cause of mortality in this population [2]. The prevalence of coronary artery disease (CAD) has been estimated to be as high as 55% in the diabetic population [3]. It has been shown that diabetes is a major independent risk factor for cardiovascular disease after adjustment for other risk factors such as age, hypertension, hypercholesterolemia, and tobacco abuse [4]. Patients with diabetes appear to develop accelerated and more severe CAD and also exhibit a diminished angiogenic response to myocardial ischemia as shown angiographically [5] and in autopsy studies [6]. This diminished angiogenic response is associated with coronary microvascular and endothelial dysfunction as well as the presence of an overall anti-angiogenic milieu leading to fewer collateral blood vessels [7, 8]. Hyperglycemia, hyperinsulinemia, and insulin resistance further add to the development of CAD, cardiomyopathy, and heart failure (Fig. 24.1). This culminates in a greater tendency toward more frequent and more severe adverse cardiovascular events. The relative risk of myocardial infarction is 50% greater in diabetic men and 150% greater in diabetic women [9]. Approximately, 20–30% of patients who have undergone coronary artery bypass grafting (CABG) have diabetes mellitus [10]. Thus, diabetic patients undergoing surgical coronary revascularization represent a large and complex patient population. There continue to be advancements in both percutaneous coronary interventions (PCI), primarily the use of drug-eluting stents, and surgical techniques, such as off-pump CABG and the use of multiple arterial grafts, that have continued to improve methods of coronary revascularization. While there is evidence to suggest that these new techniques have improved outcomes in diabetic patients [11], the optimal treatment for multivessel CAD continues to evolve for the diabetic patient population, which still suffers from worse long-term outcomes compared to the nondiabetic population.

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Authors and Affiliations

  1. Division of Cardiac Surgery, Tufts Medical Center, Boston, MA, USA

    Michael P. Robich

  2. Department of Surgery, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, USA

    Frank W. Sellke

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  1. Michael P. Robich
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  2. Frank W. Sellke
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Correspondence to Frank W. Sellke .

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  1. Steward St. Elizabeth’s Medical Center, Tufts University Medical School, Brighton, MA, USA

    Michael Johnstone

  2. Beth Israel Deaconess Medical Center / Harvard Medical School, Boston, MA, USA

    Aristidis Veves

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Robich, M.P., Sellke, F.W. (2023). Cardiac Surgery and Diabetes Mellitus. In: Johnstone, M., Veves, A. (eds) Diabetes and Cardiovascular Disease. Contemporary Cardiology. Humana, Cham. https://doi.org/10.1007/978-3-031-13177-6_26

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