Increasing Prevalence
Diabetes is an increasingly common disorder in the United States. It affects an estimated 20.6 million American adults aged 20 and older, 9.7 million of whom are women.42 The prevalence of diabetes in the United States has risen by more than 60% since 1990,2 and it is expected to continue growing. In 2004, the U.S. Department of Health and Human Services reported that 40% of US adults aged 40 to 74 have pre-diabetes, which increases their odds of developing diabetes.2
Diabetes and Cardiovascular Risk
- Cardiac death rates are 2- to 4-times higher among diabetic adults compared with their nondiabetic counterparts.2
 65% of diabetic patients die from some form of heart or blood vessel disease.2
- Diabetic women are at greater risk of heart disease than diabetic men.45
- Coronary artery disease (CAD) is the leading cause of death among diabetic women.46
Diabetes and Silent Ischemia
Physicians should be aware that diabetic patients appear to be at increased risk for silent ischemia. The pain response to ischemia is often blunted in diabetic patients,77 and therefore ischemic disease may not trigger symptoms.
In the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study47:
- 22% of patients randomized to undergo pharmacologic-stress myocardial perfusion imaging (MPI) had silent ischemia.
- 41% of patients with silent ischemia would not have been identified by screening based on American Diabetes Association guidelines.
|
Diabetes
Obesity
Metabolic Syndrome
Race/Ethnicity
Defining Risk in Women
Exercise Capacity in Women
C-Reactive Protein
Atrial Fibrillation
Heart Failure
Fat Distribution and Heart Disease in Women
Fitness Levels
Rheumatoid Arthritis
Aging
|
CAD Detection in Diabetics
Diabetic patients are at increased risk for heart disease, and those with CAD can often be asymptomatic or can present with atypical symptoms.77 Therefore, diabetics may require more frequent cardiac testing.46
Diagnosis of CAD can be more difficult in the presence of diabetes:
- Exercise electrocardiography (ECG) can be a less reliable indicator of significant CAD in diabetics.7
- The value of exercise ECG in the cardiac assessment of diabetics may be compromised by decreased exercise capacity, inability to reach target heart rates, and absence of chest pain during exercise.7,77
- MPI with stress single-photon emission computed tomography (SPECT) has significant prognostic and risk-stratification value in diabetic patients.46,78
- Due to their limited ability to exercise, more diabetic than nondiabetic patients require pharmacologic stress for imaging procedures. In a large study of patients referred for SPECT MPI, significantly more diabetics required pharmacologic stress (Figure 8).46
|
|
