Heart in Diabetes: Not Only a Macrovascular Disease

The importance of diabetes as a cause of mortality and morbidity is well known. The number of patients increases alongside aging of the population, raising the prevalence of obesity and a sedentary lifestyle. As a disease that is strongly associated with both micro- and macrovascular complications, diabetes results in organ and tissue damage. Cardiovascular disease (CVD) causes up to 70% of all deaths in people with diabetes. The epidemic of diabetes will thus be followed by an epidemic of diabetes-related vascular diseases. Almost two of three patients who present with symptomatic chronic heart disease have abnormal glucose homeostasis. Although the mortality from coronary artery disease (CAD) in patients without diabetes has declined over the past 20 years, the mortality in men with type 2 diabetes has not changed significantly. Moreover, diabetes is an independent risk factor for heart failure, and there are a substantial number of patients with diabetes and heart failure. The main macrovascular complications, for which diabetes has been a well-established risk factor throughout the cardiovascular system, are CAD, peripheral vascular disease, increased intima-media thickness, and stroke. Ischemic heart disease and stroke account for the highest proportion of comorbid diseases associated with diabetes. The joint guidelines of the European Society of Cardiology and the European Association of Diabetes take into account the close reciprocal relationship between diagnostics and therapeutics in cardiology and diabetology. Patients with diabetes and CVD have an unfavorable prognosis (1). Mortality rates due to heart disease are two to four times higher among people with diabetes compared with those without diabetes after correction for traditional risk factors for CVD such as age, obesity, smoking, dyslipidemia, and hypertension. It appears, however, that the presence of even one of these risk factors leads to poorer outcomes among people with diabetes compared with those without diabetes. People with …