Diabetic Cardiology

With cardiovascular disease becoming the most common cause of death in people with diabetes, interest in the assessment and treatment of heart disease in these patients has been reawakened. This book examines developing topics from a largely cardiological perspective, covering both pharmacological and non-pharmacological interventions.

The DIGAMI study on the use of intravenous insulin infusion at the time of myocardial infarction (MI) has stimulated a large number of discussion papers on the best treatment of MI in the diabetic patient. The UKPDS has shown that treatment of Type 2 diabetes does not reduce cardiovascular end-points significantly, but that aggressive treatment of blood pressure can do so. In addition, sub-group analysis from several large cardiovascular trials has shown that treatment with statins, anti-platelet therapy, ACE inhibitors and other drugs will also reduce cardiovascular events in people with diabetes.

List of contributors.

Introduction.

1. Epidemiology of vascular disease in diabetes (Susan Laing).

1.1 Introduction.

1.2 The Role of Epidemiological Studies.

1.3 Cohort Studies of People with Diabetes.

1.4 Cardiovascular Disease and Diabetes.

1.5 Mortality from Coronary Heart Disease.

1.6 Mortality from Cerebrovascular Disease.

1.7 Discussion.

References.

2. Pathogenesis of atherosclerosis and vascular disease in type 2 diabetes (Naveed Sattar and Alistair Cormack).

2.1 Introduction.

2.2 What is Insulin Resistance?

2.3 Dyslipidaemia and Type 2 Diabetes.

2.4 Hypertension.

2.5 Endothelial Dysfunction and Type 2 Diabetes.

2.6 Inflammation.

2.7 Adipokines – Adiponectin.

2.8 Haemostatic Changes in Type 2 Diabetes.

2.9 Hyperinsulinaemia.

2.10 Role of Hyperglycaemia.

2.11 Metabolic Syndrome as a Link between Insulin Resistance and CVD?

2.12 Effects of Anti-diabetic Drugs on Risk Factor Pathways.

2.13 Conclusions.

References.

3. Coronary heart disease and diabetes (Colin Berry, Miles Fisher and John McMurray).

3.1 Nature of Coronary Heart Disease in Diabetes.

3.2 Presentation of CHD in Diabetes.

3.3 Non-invasive Investigation.

3.4 Pharmacological Treatment of CHD in People with Diabetes.

3.5 Coronary Revascularisation in Diabetes.

3.6 Stents for Coronary Artery Disease in Diabetes.

3.7 Drug-eluting Stents.

3.8 Drug Therapy and PCI in Diabetic Patients.

3.9 Conclusions.

References.

4. Diabetes and acute coronary syndromes (Colin Berry, Miles Fisher and John McMurray).

4.1 Introduction.

4.2 Antiplatelet Agents.

4.3 Thrombolysis.

4.4 Beta-blockers.

4.5 ACE Inhibitors.

4.6 Angiotensin Receptor Blockers.

4.7 Heparin.

4.8 Glycoprotein IIb/IIIa Inhibitors.

4.9 Revascularisation for Acute Coronary Syndromes.

4.10 Device Therapy Post-MI.

4.11 Management of Glycaemia.

4.12 Conclusions.

References.

5. Diabetes, left ventricular systolic dysfunction and chronic heart failure (Michael R MacDonald, Mark C Petrie, Nathaniel M Hawkins and John J V McMurray).

5.1 Introduction.

5.2 Prevalence.

5.3 Incidence.

5.4 Risks of Developing CHF and Diabetes.

5.5 Diabetes and Mortality in Patients with CHF.

5.6 Morbidity.

5.7 Chronic Heart Failure and Abnormalities of Insulin and Glucose Metabolism.

5.8 Why do Patients with Diabetes develop CHF?

5.9 Reducing the Risk of Diabetes in Patients with CHF.

5.10 Reducing the Development of CHF in Patients with Diabetes.

5.11 Treatment of Diabetes in Patients with CHF.

5.12 Treatment of CHF in Patients with Diabetes.

5.13 Conclusions.

References.

6. Diabetes and hypertension (Gordon T McInnes).

6.1 Introduction.

6.2 Metabolic Syndrome.

6.3 Risk Stratification.

6.4 Strategies to Reduce Cardiovascular Risk.

6.5 Strategies to Reduce Kidney Disease Risk.

6.6 Risk of Diabetes Mellitus with Antihypertensive Drugs.

6.7 Conclusions.

References.

7. Diabetes and strokes/transient ischaemic attacks (Christopher S Gray and Janice E O'Connell).

7.1 Introduction.

7.2 Diabetes as a Risk Factor for Stroke.

7.3 Diabetes, Post-stroke Hyperglycaemia and Outcome from Stroke.

7.4 Hyperglycaemia and Ischaemic Cerebral Damage.

7.5 Management of Diabetes and Hyperglycaemia following Stroke.

7.6 Prevention of Stroke in Diabetic Patients.

7.7 Diabetes, Cognitive Impairment and Dementia.

7.8 Conclusions.

References.

8. Diabetes and peripheral arterial disease (Iskandar Idris and Richard Donnelly).

8.1 Introduction.

8.2 Pathogenesis.

8.3 Clinical Features of PAD in Patients with Diabetes.

8.4 Lower Extremity Revascularisation in Patients with Diabetes.

8.5 Medical Therapy of PAD in Diabetes.

8.6 Future Therapy for PAD.

8.7 Conclusions.

References.

9. Prevention of cardiovascular events in diabetic patients (Markku Laakso).

9.1 Introduction.

9.2 Coronary Artery Disease in Type 2 Diabetes.

9.3 Potential and Proven Risk Factors for Atherothrombosis in Patients with Type 2 Diabetes.

9.4 Treatment Effects of Cardiovascular Risk Factors on the Risk of CAD in Type 2 Diabetes.

9.5 Summary.

Acknowledgements.

References.

10. Prevention of diabetes as a means of preventing cardiovascular disease (Stephen J Cleland and Jonathan Shaw).

10.1 Hyperglycaemia as a Risk Factor for Cardiovascular Disease.

10.2 Risk of Cardiovascular Disease in Pre-diabetes.

10.3 Intervention Trials in Pre-diabetes.

10.4 Screening for Pre-diabetes.

10.5 Summary and Conclusions.

References.

11. Diabetes for cardiologists (David MacFarlane, Colin Perry and Miles Fisher).

11.1 Introduction.

11.2 Epidemiology of Diabetes Mellitus.

11.3 New Diagnostic Criteria for Diabetes Mellitus.

11.4 Metabolic Syndrome.

11.5 Treatment of Diabetes Mellitus.

11.6 Hypoglycaemia.

11.7 Treatment of Type 2 Diabetes.

11.8 Conclusions.

References.

Acronyms.

Index.

"For diabetologists and practitioners. Though rare, uncontrolled diabetes causes heart disease also in adolescents. Thus also of interest for pediatric endocrinologists who have the responsibility of preventing these disabling complications." (Pediatric Endocrinology Reviews, June 2010)

"This book I am sure would be welcomed as an evidence-base resource by most diabetic specialists ... I would also recommend it for all those in primary care with an interest in vascular disease and diabetes." (Practical Diabetes International, October 2008)

"This excellent book…provides a useful meeting point for two specialities that do not routinely associate together." (Lancet, May 2008)

Miles Fisher, Consultant Physician, Glasgow Royal Infirmary

John McMurray, Professor of Medical Cardiology, British Heart Foundation Cardiovascular Research Centre, University of Glasgow and Honorary Consultant Cardiologist, Western Infirmary, Glasgow

Cardiovascular disease is the most common cause of death in people with diabetes. Interest in the assessment and treatment of heart disease has been reawakened because of many factors, including the results of several multi-centre studies. The UKPDS showed that treatment of Type 2 diabetes did not reduce cardiovascular end-points significantly, but that aggressive treatment of blood pressure could do so. The more recent PROactive study showed that treatment with pioglitazone could reduce myocardial infarctions and strokes in diabetic patients with previous myocardial infarction or stroke. In addition, sub-group analysis from several large cardiovascular trials has shown that treatment with statins, anti-platelet therapy, ACE inhibitors and other drugs will also reduce cardiovascular events in people with diabetes. The DIGAMI studies on the use of intravenous insulin infusion at the time of myocardial infarction stimulated a large number of discussion papers on the best treatment of MI and acute coronary syndromes in the diabetic patient.

This book reviews the evidence from such trials and looks at developing topics in diabetes and cardiovascular disease from a largely cardiological perspective. It covers both pharmacological and non-pharmacological interventions and also considers both prevention and treatment options, including the management of coronary heart disease, congestive cardiac failure, hypertension, stroke disease and peripheral vascular disease.

With heart disease increasingly in the news related to diabetes, and rising numbers of patients with these co-morbidities, this book will be essential reading for healthcare professionals engaged in the care of patients with diabetes and associated cardiovascular disease.