Diabetes as a cause of heart disease

In patients with diabetes mellitus (DM), compared with patients without diabetes, there is an increased prevalence of atherosclerosis and coronary heart disease (CHD), as well as higher rates of morbidity and mortality after acute coronary syndrome and myocardial infarction. An analysis of the data collected in the OASIS registry during an average of 2 years of monitoring patients who were hospitalized for NS or HeQ-MI showed that diabetes significantly increased all-cause mortality and the incidence of new MI, MI, and HF. A similar study involving patients hospitalized with confirmed myocardial infarction (MI) showed that the presence of diabetes is associated with an adjusted risk ratio of death of 1.7 (95% CI 1.2-2.3) compared with patients without diabetes and myocardial infarction. history. DM is also likely to be the main cause of higher rates of early and late mortality among women hospitalized with AMI compared with men. In general, diabetes mellitus additionally increases the risks to the same extent as a history of MI, and the number of CVDs associated with diabetes is increasing. In New York for the period 1989-1999. the frequency of myocardial infarction in patients with diabetes mellitus (DM) among all patients with AMI increased from 21 to 36%, and the number of hospital days associated with myocardial infarction increased by 51%, despite a decrease in the number of hospital days associated with myocardial infarction populations. A relatively recent study of the causes of the sharp decline in mortality from coronary heart disease in the UK since 1981 showed that the decline occurred despite negative trends in obesity, diabetes and physical activity in the population. Over the 19 years of the study, diabetes incidence increased by 66%, resulting in = 2900 additional deaths from coronary heart disease associated with diabetes. In the past, at least in part, the increase in cardiovascular risk (CVD) associated with diabetes was caused by improper standard therapeutic interventions that improve the outcomes of CVD in patients without diabetes. For example, patients with diabetes often were not prescribed β-AB after MI because of the fear that these drugs might mask hypoglycemia and disrupt glycemic control. Recent evidence suggests that patients with MI and diabetes may even respond better to standard treatments than patients without diabetes. In the register of a large study conducted in Germany, the overall nosocomial mortality of patients with diabetes mellitus hospitalized for myocardial infarction decreased from 29% in 1999 to 17% in 2001, and mortality within 24 hours after admission decreased from 16 to 4% for the same period. This decrease was associated with the increased use of therapeutic approaches (e.g., coronary angiography, stenting, antiplatelet therapy) in patients with diabetes during this period. Similarly, in a study comparing invasive and non-invasive treatment strategies for unstable angina pectoris (NS) in patients with diabetes and without diabetes, it was shown that invasive treatment has greater relative efficacy in patients with diabetes (OR 0.61) compared with patients without diabetes (OS 0.72), although mortality and the frequency of repeated MI within 12 months were still higher in patients with diabetes, regardless of the type of therapy. A retrospective analysis of the results for patients with diabetes and myocardial infarction ↑ ST who received reteplase or a combination of reteplase with abciximab showed that although combination therapy significantly reduces the incidence of repeated myocardial infarction, recurrent ischemia and emergency revascularization, the outcome of myocardial infarction is worse than in patients without diabetes SD Traditional risk factors (RF) for coronary heart disease (coronary heart disease), such as hypertension, DLP, excessive MT, and obesity, are common in patients with NTG or diabetes, but their frequency cannot explain the entire increased risk in these patients. In addition to the traditional FR associated with CHD and HF, there are specific for the FR, which contributes to an increase in the incidence and mortality from CHF. For example, in patients with diabetes, AB is rich in lipids, therefore, more vulnerable to rupture than AB in patients without diabetes. Investigation of AB from the carotid arteries of patients with diabetes undergoingendarterectomy, shows that AB contains more inflammatory cells and inflammatory markers and have a higher lipid content than AB in patients without diabetes. This increased vascular inflammatory response may occur as a result of overexpression of CNG receptors, which linearly correlates with the level of HbA1C. Receptors of glycolization end products (CNGs) can enhance the activity of matrix metalloproteinase, which destabilizes AB. In addition, platelets in patients with diabetes are capable of enhanced aggregation and increased expression of activation-dependent adhesion molecules, such as GP IIb / IIIa and CD40 ligand, which contribute to the formation of a thrombus. Changes in vascular function may also be responsible for worse outcomes in patients with diabetes. The no reflow phenomenon after successful angioplasty of a heart attack-associated CA is more common in the presence of diabetes and / or hyperglycemia and can lead to LV dysfunction. Under these conditions, the no reflow phenomenon is likely to result from the interaction of platelets and endothelial cells, which disrupt microcirculation and reduce coronary blood flow. In patients with diabetes, there is an increased level of plasminogen activator inhibitor 1 (IAP-1) in plasma and AB. Elevated levels of IAP-1 in the tissue can weaken fibrinolysis, increase blood clot formation and accelerate the formation of AB. Other functional vascular changes may be an increase in the activity of endothelin and a decrease in the activity of prostacyclin and NO, which leads to a violation of the regulation of blood flow. Diabetes also increases the risk of developing heart failure. The likelihood of heart failure in patients with diabetes is 2-5 times higher than in patients without diabetes, and after the development of heart failure in patients with diabetes, there is a higher mortality rate and complication rate of heart failure. In patients with and without diabetes, the main causes of heart failure are the same. In both groups, the development of MI and, as a consequence, the loss of part of the contracted myocardium in most cases are the cause of heart failure. Other causes of heart failure in patients with diabetes are hypertension, LVH, and heart defects. Although diabetes is an important risk factor for heart failure, diabetes rarely develops independently and is usually exacerbated by other drugs. It was established that KBS is associated with the activation of the inflammatory reaction, therefore, the increase in plasma SRV observed in patients with diabetes reflects an increased risk. Other diabetes-specific changes include diabetic CMP, which reduces myocardial contractility, makes it more susceptible to ischemia and less able to recover from it, and diabetic autonomic neuropathy, which leads to an imbalance of the sympathetic and parasympathetic parts of the nervous system and contributes to the cardiovascular mortality. Glycosylation end products (CNGs) may be involved in many of the changes associated with diabetes.

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