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Perspectives

How does diabetes damage the heart? The clock starts ticking early

Lesley V Campbell

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Abstract

Type 2 diabetes is a major cause of cardiovascular events and mortality. Despite this knowledge, optimal treatment of coronary risk factors for people with type 2 diabetes is not widespread.

Key Points

  • Cardiovascular disease causes more than 70% of deaths in people with type 2 diabetes.
  • Atheroma in patients with diabetes develops silently preceding hyperglycaemia, particularly when features of the metabolic syndrome are present.
  • Classic coronary risk factors in people with diabetes (including hypercholesterolaemia and hypertension) contribute to the atheroma and should be actively treated, remembering that women in particular may be undertreated.
  • Additional risk factors specific to diabetes (such as dyslipidaemia, central obesity, hyperglycaemia and autonomic neuropathy) accelerate atheroma in people with type 2 diabetes or can worsen the outcome.

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