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Heart 99:743-749 doi:10.1136/heartjnl-2011-301172
  • Education in Heart
  • Diabetic heart disease

Methods of accelerated atherosclerosis in diabetic patients

  1. Gerard Pasterkamp
  1. Department of Cardiology, Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands
  1. Correspondence to Professor Gerard Pasterkamp, Department of Cardiology, Laboratory of Experimental Cardiology, University Medical Center Utrecht, Heidelberglaan 100, Room G02-523, Utrecht 3584CX, The Netherlands; g.pasterkamp{at}umcutrecht.nl

Diabetic patients have an increased risk of cardiovascular disease (CVD), which is a major contributor to morbidity and mortality in the aging population, and have a more than twofold increase in the risk of dying from CVD.1 Even patients with pre-diabetes, as detected by abnormal glucose tolerance tests, have an increased risk of developing disabling stroke, peripheral artery disease, and myocardial infarction. Healthcare spending for people with diabetes is more than double the expenditure on those without diabetes, and a significant part of these costs is explained by CVD comorbidity. This article will focus on the effect of diabetes on the initiation and progression of arterial occlusive disease, preceded by a short outline of the enormous impact of this issue from a societal-economic perspective.

Diabetes, a major healthcare issue

The prevalence and associated costs of diabetes are expected to increase significantly. There are currently over 240 million people with diabetes worldwide. By 2025, the number of people with diabetes is expected to more than double in South-East Asia, the Eastern Mediterranean, the Middle East, and Africa (source: World Diabetes Foundation). The incidence is projected to rise by nearly 20% in Europe and 50% in North America. Worldwide more than 50% of people with diabetes are unaware of their condition and are therefore not treated. About 40% of people with diabetes will develop chronic kidney disease which further increases the risk of CVD and other complications. Evidence from observational studies shows that hyperglycaemia is an important risk factor for CVD; in people with diabetes (types 1 and 2) the risk of CVD increases with increasing concentrations of glycated haemoglobin (HbA1c), independently of clinical characteristics and other traditional risk factors.2

The economic impact of diabetes (types 1 and 2) is substantial. Health expenditure to treat and prevent diabetes and its complications is estimated to total …