| Diabetes puts patients at increased risk for CHD and associated complications.17 Compared with nondiabetics, diabetics have a 2- to 4-times increased rate of death from heart disease.42 At least 65% of people with diabetes die from some type of heart or blood vessel disease.2 Diabetes has been called a "CHD risk equivalent."43 While this designation is still being debated, there is no question that diabetes has a significant negative impact on cardiovascular health.
Since 1990, the prevalence of diagnosed diabetes in the US has risen by 61%.44 More than 9 million women aged 20 years or older have diabetes.42 Women with diabetes are at higher risk for heart disease than their male counterparts.45 Also, among all women with CAD, the rate of MI and cardiac death is significantly higher for those who also have diabetes.46
Diabetics are also at higher risk for silent ischemia (ie, asymptomatic coronary disease). In the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study, 22% of patients (aged 50 to 75 years) randomized to undergo pharmacologic-stress nuclear imaging were found to have silent ischemia, and 41% of those cases would not have been identified by screening based on American Diabetes Association guidelines alone.47
Additionally in the DIAD study, pharmacologic stress-induced ST depression was more common in women, both with and without perfusion abnormalities.47 Pharmacologic stress-induced ST depression is a predictor of significant CAD and poor cardiac outcomes.47 The findings of the DIAD study indicate that totally asymptomatic diabetics have at least an intermediate probability of having CAD.47 |
Risk Factors
Office-Based Risk Assessment
Risk Reduction
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