Diabetes and Atherosclerosis
Top Cited Papers
- 15 May 2002
- journal article
- review article
- Published by American Medical Association (AMA) in JAMA
- Vol. 287 (19), 2570-2581
- https://doi.org/10.1001/jama.287.19.2570
Abstract
Context Complications of atherosclerosis cause most morbidity and mortality in patients with diabetes mellitus. Despite the frequency and severity of disease, proven medical therapy remains incompletely understood and underused. Objective To review the epidemiology, pathophysiology, and medical and invasive treatment of atherosclerosis in patients with diabetes mellitus. Data Sources Using the index terms diabetes mellitus, myocardial infarction, peripheral vascular diseases, cerebrovascular accident, endothelium, vascular smooth muscle, platelets, thrombosis, cholesterol, hypertension, hyperglycemia, insulin, angioplasty, and coronary artery bypass, we searched the MEDLINE and EMBASE databases from 1976 to 2001. Additional data sources included bibliographies of identified articles and preliminary data presented at recent cardiology conferences. Study Selection We selected original investigations and reviews of the epidemiology, pathophysiology, and therapy of atherosclerosis in diabetes. We selected randomized, double-blind, controlled studies, when available, to support therapeutic recommendations. Criteria for data inclusion (168 of 396) included publication in a peer-reviewed journal or presentation at a national cardiovascular society–sponsored meeting. Data Extraction Data quality was determined by publication in peer-reviewed literature. Data extraction was performed by one of the authors. Data Synthesis Diabetes mellitus markedly increases the risk of myocardial infarction, stroke, amputation, and death. The metabolic abnormalities caused by diabetes induce vascular dysfunction that predisposes this patient population to atherosclerosis. Blood pressure control, lipid-lowering therapy, angiotensin-converting enzyme inhibition, and antiplatelet drugs significantly reduce the risk of cardiovascular events. Although diabetic patients undergo revascularization procedures because of acute coronary syndromes or critical limb ischemia, the outcomes are less favorable than in nondiabetic cohorts. Conclusions Since most patients with diabetes die from complications of atherosclerosis, they should receive intensive preventive interventions proven to reduce their cardiovascular risk.Keywords
This publication has 93 references indexed in Scilit:
- Prevalence and clinical implications of American Diabetes Association-defined diabetes and other categories of glucose dysregulation in older adults: The Health, Aging and Body Composition StudyJournal of Clinical Epidemiology, 2001
- In-hospital Outcome for Diabetic Patients with Acute Myocardial Infarction in the Thrombolytic EraScandinavian Cardiovascular Journal, 1999
- Mortality from Coronary Heart Disease in Subjects with Type 2 Diabetes and in Nondiabetic Subjects with and without Prior Myocardial InfarctionThe New England Journal of Medicine, 1998
- Impact of Diabetes on Mortality After the First Myocardial InfarctionDiabetes Care, 1998
- Effect of Diagnostic Criteria on the Prevalence of Peripheral Arterial DiseaseCirculation, 1995
- Carotid plaque, aging, and risk factors. A study of 457 subjects.Stroke, 1994
- Ankle-arm index as a marker of atherosclerosis in the Cardiovascular Health Study. Cardiovascular Heart Study (CHS) Collaborative Research Group.Circulation, 1993
- Glucose tolerance and the risk of cardiovascular diseases: The zutphen studyJournal of Clinical Epidemiology, 1992
- 5-year incidence of atherosclerotic vascular disease in relation to general risk factors, insulin level, and abnormalities in lipoprotein composition in non-insulin-dependent diabetic and nondiabetic subjects.Circulation, 1990
- Update on Some Epidemiologic Features of Intermittent Claudication: The Framingham StudyJournal of the American Geriatrics Society, 1985