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Diabetic heart disease
Management of diabetes in cardiovascular patients
  1. R Peter,
  2. A Cox,
  3. M Evans
  1. Llandough Hospital, Llandough, Cardiff, UK
  1. Dr Marc Evans, Llandough Hospital, Llandough, Cardiff, C46 4XW, UK; marc.evans2{at}ntlworld.com

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Type 2 diabetes mellitus (T2DM) is a common disease affecting ∼3–5% of people living in the western world. Cardiovascular disease (CVD) (coronary heart disease (CHD), stroke and peripheral vascular disease) is the most important cause of mortality and morbidity among patients with T2DM. Compared with a non-diabetic individual, a person with T2DM has a two- to fourfold increased risk of dying from a myocardial infarction (MI)w1 w2 or a strokew1 w3 and a 10- to 15-fold increased risk of a lower extremity amputation.1 w4 Norhammar et al in 2002 reported that on the basis of an oral glucose tolerance test, ∼65% of patients admitted with acute MI but without known history of diabetes had either frank diabetes or impaired glucose tolerance,2 with glucose values after day 4 post-event being highly predictive of incident diabetes. More recently Tuomelhto’s group similarly reported that in patients presenting with acute stroke only ∼20% had normal glucose values.3 It may thus be considered that presentation with an acute coronary event represents an indication for formal diabetes screening with a 75 g oral glucose tolerance test conducted at day 4 post-event.

Haffner et al first reported that middle aged subjects with diabetes but without a history of MI had the same risk for an ischaemic event over a 7 year observation period as a group of subjects without diabetes but with a past history of MI.4 In another study in patients hospitalised with a confirmed MI, those with diabetes manifested a higher mortality during a mean follow up of 3.7 years. The magnitude of the effect of diabetes on mortality was similar to that produced by a history of previous MI.w5 The Organisation to Assess Strategies for Ischemic Syndromes reported similar results.w6 In a recent study, patients presenting …

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