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Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Epidemiology of Insulin Resistance,Diabetes Mellitus,and Coronary Heart Disease,Steven Haffner,MD,Adapted from World Health Organization.,Definition,Diagnosis and Classification of Diabetes Mellitus,and its Complications.,Geneva:World Health Organization:1999:52.,Criteria for the Diagnosis of Diabetes Mellitus and Hyperglycemia,Plasma Glucose Concentration,7.0(,126),6.1(,110),to 7.0(,11.1(,200),7.8(,140),to11.1(,20 years)by Year and Region,2000,2025,Hospitalization Costs for Chronic Complications of Diabetes in the US,American Diabetes Association.,Economic Consequences of Diabetes Mellitus,in the US in 1997,.Alexandria,VA:American Diabetes Association,1998:1-14.,Total costs 12 billion US$,CVD accounts for 64%of total costs,Others,Ophthalmic disease,Cardiovasculardisease,Renal disease,Neurologic disease,Peripheral vascular disease,Annual CHD Deaths per 1000 Persons,Kannel WB,McGee DL.,JAMA,1979;241:2035-2038.,Framingham Study:DM and CHD Mortality,20-Year Follow-up,17,8,17,4,Men,Women,DM,Non-DM,Ischemicheartdisease,%,of Deaths,Geiss LS et al.In:,Diabetes in America,.2,nd,ed.1995;chap 11.,Mortality in People with Diabetes,Causes of Death,Otherheartdisease,Diabetes,Cancer,Stroke,Infection,Other,Mortality per 1000 person-years*,*,Age-adjusted,Adapted from Gu K et al.,Diabetes Care,1998;21:1138-1145.,Mortality Due to Heart Disease in Men and Women with or without Diabetes(US),29.9,19.2,Men,Women,Diabetes,No Diabetes,All heart disease,Ischemic heart disease,Men,Women,11.5,6.3,23.0,7.1,11.0,3.6,Nondiabetes,Diabetes,*,Defined in 1971-1975,followed up through 1982-1984.*Defined in 1982-1984,followed up through 1992-1993.,Gu K et al.,JAMA,1999;281:1291-1297.,Trends in Mortality Rates for Ischemic Heart Disease in NHANES Subjects with and without Diabetes*,17.0,6.8,-16.6%,+10.7%,Men,cohort 1*,Men,cohort 2*,Women,cohort 1*,Women,cohort 2*,-43.8%,-20.4%,14.2,7.6,7.4,4.2,2.4,1.9,(,P,=0.46),(,P,=0.76),(,P,200 mg/dl,smoking,SBP 120 mmHg,Stamler J et al.,Diabetes Care,1993;16:434-444,All three,No diabetes,Diabetes,Two only,Putative Mechanism for Increased Atherosclerosis in Type 2 Diabetes,BLACK BOX,Dyslipidemia,Hypertension,Hyperinsulinemia,/insulin resistance,Hemostatic,abnormalities,Hyperglycemia,AGE proteins,Oxidative stress,AGE=advanced glycation end products,Adapted from Bierman EL.,Arterioscler,Thromb,1992;12:647-656.,+=,moderately increased compared with nondiabetic population,+=markedly increased compared with nondiabetic population,=not different compared with nondiabetic population,Prevalence of Cardiovascular Risk Factors in Diabetic Subjects Relative to Nondiabetics,Type 1,Dyslipidemia Hypertriglyceridemia Low HDL Small,dense LDL Increased apo B,Hypertension,Hyperinsulinemia/insulin resistance,Central obesity,Family history of atherosclerosis,Cigarette smoking,Adapted from Chait A,Bierman EL.In:,Joslins Diabetes Mellitus,.Philadelphia:Lea&Febiger,1994:648-664.,Type 2,Risk Factor,+,+,+,+,+,+,+,+,+,+,Differences in HDL Cholesterol and LDL Size by Diabetic Status in Women and Men,Howard BV et al.,Diabetes Care,1998;21:1258-1265.,0,-2,-4,-6,-8,Differences between participants with and without diabetes,HDL Cholesterol,LDL Size,0,-2,-4,-6,-8,mg/dL,Women,Men,Women,Men,Strategies for Reduction of Diabetic Complications,Microvascular,complications-Aggressive screening-Improved metabolic control,Macrovascular,complications-Improved,glycemic,control(positive but minor)-Prevention of type 2 diabetes-Aggressive treatment of established CVRF in diabetic and possibly,prediabetic,subjects-Diabetic agents that improve cardiovascular risk,Incidence Rates of MI and Microvascular Endpoints by Mean Systolic Blood Pressure:,UKPDS,110,120,130,140,150,160,170,Incidence per 1000 Person Years(%),Adler AI et al.,BMJ,2000;321:412-419.,Updated Mean Systolic Blood Pressure(mmHg),Adjusted for age,sex,and ethnic group,Myocardial Infarction,Microvascular Endpoints,Incidence Rates of MI and Microvascular Endpoints by Mean Hemoglobin,A,1c,:,UKPDS,5,6,7,8,9,10,11,Incidence per 1000 Person Years(%),Stratton IM et al.,BMJ,2000;321:405-412.,Updated Mean Hemoglobin A,1c,Concentration(%),Adjusted for age,sex,and ethnic group,Myocardial Infarction,Microvascular Endpoints,Plasma Insulin and Triglycerides Predict Ischemic Heart Disease:,Quebec Cardiovascular Study,Despres JP et al.,N Engl J Med,1996;334:952-957.,Odds Ratio,15,F-Insulin(,U/ml),4.6,p=0.005,150,mg/dl,150,mg/dl,Triglycerides,1.0,1.5,5.3,p=0.001,P0.001,6.7,5.4,P=0.002,Plasma Insulin and Apolipoprotein B Predict Ischemic Heart Disease:,Quebec Cardiovascular Study,Despres JP et al.,N Engl J Med,1996;334:952-957.,Odds Ratio,15,F-Insulin(,U/ml),3.0,p=0.04,119,mg/dl,119,mg/dl,Apolipoprotein B,1.0,1.5,3.2,p0.001,11.0,9.7,P25.64,25.64,LDL Peak Particle Diameter(nm),1.0,1.0,6.2,(,p120,mg/dl,2.0,120,mg/dl,Baseline Anthropometric Variables and Cardiovascular Risk Factors in Subjects with,
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