DIABETES-MELLITUS AND CORONARY HEART-DISEASE IN THE ELDERLY

Data from epidemiologic studies document the role of clinically manife st diabetes mellitus as a powerful risk determinant for an array of at herosclerotic cardiovascular outcomes including coronary heart disease (CHD), stroke, and peripheral arterial disease, particularly in the e lderly. Although dyslipidemias and hypertension are quite prevalent in persons with diabetes mellitus and contribute heavily to the underlyi ng atherosclerotic process, other factors involving alternative pathog enetic mechanisms are necessary to explain for the dramatic accelerati on of atherogenesis observed in this condition. Myocardial ischemia ma y be silent and myocardial infarction (MI) may be either painless or a typical in presentation which further complicates both the diagnostic and therapeutic management of CHD in older diabetic patients. MI, in t his context, is confounded by dual prognostic disadvantages of higher risk for MI-related complications attributable to both advanced age an d diabetes mellitus. Because available evidence has yet to demonstrate that control of hyperglycemia, either by oral agents or by insulin, e ffectively forestalls either the development or complications of ather osclerosis, preventive management in older patients with diabetes requ ires critical attention to correcting coexisting cardiovascular risk f actors.