Diabetes, June 2007

Diabetes and Heart Disease Rates Soar

As the number of Americans with type 2 diabetes has soared over the past 50 years, so, too, has heart disease linked to the blood sugar illness, researchers say in the medical journal Circulation.

"The proportion of heart disease due to diabetes has increased about 60 percent over time," says lead author Dr. Caroline S. Fox, a medical officer at the National Heart, Lung, and Blood Institute's (NHLBI) Framingham Heart Study.

"Compared with other risk factors for heart disease, diabetes is becoming more of an issue,” she says.

The findings underscore the need to prevent diabetes and to aggressively treat and control risk factors for heart disease in people with diabetes.

Experts Emphasize Prevention

In obesity-linked type 2 diabetes, the body either does not produce enough insulin - the hormone that converts blood sugar to energy for cells - or the cells ignore the insulin. Left untreated, the disease can produce complications such as heart disease, blindness, nerve, and kidney damage.

Almost two-thirds (65 percent) of persons with diabetes will die from heart disease or stroke, according to the American Heart Association.

In this study, Dr. Fox's team collected data on 9,540 people ages 45 to 64 who participated in the Framingham Heart Study, a large population-based study.

The Framingham Study began in 1948 in Framingham, Massachusetts, and is continuing today with the third generation of study participants. The study is investigating the causes of cardiovascular disease.

The researchers used the data to compare risk factors for heart disease and cardiovascular events such as heart attacks from two different time periods. The first group was examined between 1952 and 1974, and the second group was examined between 1975 and 1998, according to the report.

They found that risk for heart disease attributable to type 2 diabetes was 5.2 percent between 1952 and 1974. However, that number jumped to 7.8 percent between 1975 and 1998. The majority of the increased risk occurred among diabetic men.

In addition, Dr. Fox's group also found that the prevalence of diabetes among those with heart disease almost doubled between the time periods. The prevalence of obesity also increased over time.

The findings echo those from a study published by the same group last June in Circulation. In that study, Dr. Fox's team looked over data on more than 3,400 Americans aged 40 to 55 who were also participating in the Framingham study.

Following the participants from the 1970s through to the 1990s, Dr. Fox and her colleagues found that rates of diabetes have doubled over that period of time.

"In terms of public health, diabetes needs to be more effectively managed with respect to cardiovascular disease management," Dr. Fox concludes. "Ultimately, diabetes needs to be prevented.”

Lifestyle Changes Needed

That includes curbing the obesity epidemic, experts say.

"This is a very important study that highlights the increased risk for cardiovascular disease that patients with diabetes face," adds Dr. Gregg Fonarow, a professor of clinical medicine at the University of California, Los Angeles.

"There is an urgent need to aggressively treat all patients with diabetes with cardiovascular protective medications, risk factor control, and lifestyle change as recommended in national guidelines," says Dr. Fonarow.

Always consult your physician for more information.

Online Resources

(These links are provided for the education and convenience of our Neighbors. AAMC is not responsible for the content of Internet sites.)

American Diabetes Association

American Dietetic Association

American Heart Association

CDC - Diabetes Public Health Resource

Centers for Disease Control and Prevention (CDC)

Circulation ? Increasing Cardiovascular Disease Burden Due to Diabetes Mellitus

Everyday Choices - ADA, AHA, and ACS

Framingham Heart Study

National Diabetes Education Program

National Diabetes Information Clearinghouse

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

National Institutes of Health (NIH)

Prevengamos la diabetes tipo 2. Paso a Paso

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Diabetes Testing Defined

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK):

Persons over age 45 should be tested for diabetes. If the first blood glucose test is normal, they should be re-tested every three years.

Persons under age 45 should be tested for diabetes if they are at high risk for diabetes based on these factors:

• being more than 20 percent over ideal body weight, or having a body mass index (BMI) of greater than or equal to 27 kg/m2
• having a first-degree relative with diabetes (mother, father, or sibling)
• being a member of a high-risk ethnic group (African-American, Hispanic, Asian, or Native American)
• delivering a baby weighing more than 9 pounds, or having diabetes during pregnancy
• having blood pressure at or above 140/90 mm/Hg
• having abnormal blood fat levels, such as high-density lipoproteins (HDL) less than or equal to 35 mg/dL, or triglycerides greater than or equal to 250 mg/dL (mg/dL = milligrams of glucose per deciliter of blood)
• having impaired glucose tolerance when previously tested for diabetes

A diagnosis of diabetes is made when any three of these tests is positive, followed by a second positive test on a different day:

• fasting plasma glucose of greater than or equal to 126 mg/dL with symptoms of diabetes
• casual plasma glucose (taken at any time of the day) of greater than or equal to 200 mg/dL with the symptoms of diabetes
• oral glucose tolerance test (OGTT) value of greater than or equal to 200 mg/dL measured at a two-hour interval. The OGTT is given over a three-hour time span.

Always consult your physician for more information.