EPIDEMIOLOGY OF MACROVASCULAR DISEASE IN DIABETES

Diabetes is a strong risk factor for all manifestations of atheroscler otic vascular disease, coronary heart disease (CHD), cerebrovascular d isease, and peripheral vascular disease, Our understanding of underlyi ng mechanisms for the accelerated atherogenesis in diabetes have, howe ver, remained poorly understood, Diabetes can be classified into two m ain subtypes: IDDM and NIDDM. The present review concentrates only on NIDDM. NIDDM is known to be associated with several adverse cardiovasc ular risk factors, including hypertension, obesity, central obesity, h yperinsulinemia, and serum lipid and lipoprotein abnormalities, charac terized mainly by elevated serum total triglycerides and HDL cholester ol, These risk factors do not, however, explain the excess of macrovas cular complications in NIDDM, and therefore increased risk must be due at least in part to diabetes itself or factors related to it, Dyslipi demias, particularly low HDL cholesterol and high levels of total trig lycerides and total cholesterol, are important risk factors for CHD in middle-aged patients with NIDDM, Also, poor metabolic control signifi cantly predicts CHD events, Hypertension, high total cholesterol, low HDL cholesterol, and high total triglycerides are significant predicto rs for stroke, The role of poor metabolic control in predicting stroke Is relatively more important than it is with respect to CHD, The most important risk factor for peripheral vascular disease is poor metabol ic control. Dyslipidemia does not consistently increase the risk for p eripheral vascular disease.