Diabetes mellitus and the Metabolic syndrome
Diabetes mellitus, a condition marked by fasting blood glucose (sugar) levels of 126 mg/dl or higher, is not only a well-established risk factor for CHD but also a disease that is becoming more prevalent at an alarming rate. This is largely due to the increasing prevalence of obesity as well as the aging of the population. The morbidity and mortality of diabetes is mostly due to atherosclerosis. In fact, having diabetes places one at the same coronary artery disease risk as someone with known coronary artery disease. It appears that diabetes confers a higher degree of risk on females than males. In other words, women with diabetes have an absolute risk for coronary events similar to diabetic men.
The metabolic changes in diabetes are complex and a major reason for the increased risk is the alteration in the lipid profile. Those with diabetes characteristically have elevated triglyceride (a specific type of lipid) levels and depressed levels of HDL. Women with diabetes have a more abnormal lipid profile, which may explain their particular susceptibility to atherosclerosis. As a result of this increased risk, a very important aspect of the care of those with diabetes should focus on optimizing their overall risk of coronary artery disease. This includes tight control of elevated blood sugars and a hemoglobin AIC (a compound in the blood that is measured with laboratory testing) of 7.0 or less. Along with aggressive control of the blood glucose level, other risk factors such as hypertension and lipid abnormalities should be optimized. The target blood pressure in a patient with diabetes is no more than 130/80 mm Hg as measured with a blood pressure cuff.
A syndrome in which multiple cardiac risk factors are present, so-called “syndrome X” or “insulin resistance syndrome,” is marked by truncal obesity (waist of 35 in. or more in women), hypertension, and glucose intolerance or frank diabetes, as well as plasma lipid abnormalities. The lipid profile in those affected by this syndrome typically is characterized by low HDL, elevated triglyceride, as well as elevated LDL. A recently conducted survey in those over 20 years of age estimates this syndrome to be present in 22.6% of women, with the highest prevalence in Mexican American women, a rate of 27.2%. As is the case in patients with diabetes, management of those with the metabolic syndrome should consist of aggressive measures targeted at reducing the multiple risk factors for coronary artery disease. This includes weight reduction, blood pressure control, management of the lipid abnormalities, as well as management of the elevated blood glucose levels.
SEE ALSO: Acute myocardial infarction, Cardiovascular disease, Cholesterol, Diabetes, Exercise, Hormone replacement therapy, Hypertension, Nutrition, Smoking
Category: Coronary Risk Factor