Diabetes mellitus
Why is type 2 diabetes mellitus a high-risk condition for coronary heart disease?
Persons with type 2 diabetes mellitus are between two and four times more likely than non-diabetics to develop CVD and two thirds of the patients with type 2 diabetes die from cardiovascular causes.
Assessing risk of coronary heart disease in patients with diabetes mellitus
Although most adult patients with diabetes mellitus are at high risk of CHD, the extent to which risk is increased varies greatly from one patient to another. It is therefore of paramount importance to assess global CHD risk in such patients in order to determine which risk factors confer the largest increase in risk for CHD and thus require the most aggressive treatment.
Metabolic syndrome
Aggregation of risk factors: the metabolic syndrome
The metabolic syndrome refers to an aggregation of atherogenic risk factors including dyslipidemia, hypertension, hyperglycemia and the presence of prothrombotic and inflammatory risk markers.
Integrating metabolic syndrome into global risk assessment
Although the metabolic syndrome increases the relative risk of CHD, its diagnosis alone is not sufficient to properly assess this risk, which should be assessed on the basis of traditional risk factors using available algorithms. The global CVD risk resulting from the presence of traditional risk factors and from the metabolic abnormalities of abdominal obesity and the metabolic syndrome has been defined as the global cardiometabolic risk.
Diabetes mellitus and metabolic syndrome: special categories of high risk
Insulin resistance plays a central role in the metabolic syndrome and is associated with atherogenic dyslipidemia and with hyperglycemia leading to diabetes and hypertension. With introduction of the NCEP ATP III clinical criteria of the metabolic syndrome, a cluster of abnormalities that were initially defined on the basis of pathophysiology (insulin resistance) was developed into an operational definition to facilitate clinical diagnosis. Thus, while the NCEP ATP III or the IDF criteria are helpful in identifying a group of individuals likely to be insulin resistant, not every patient with a clinical diagnosis of the metabolic syndrome is insulin resistant.