Diabetes and Macrovascular Disease

Kannel WB McGee DL : Diabetes and cardiovascular disease: The Framingham study JAMA 1979, 241:2035–2038.

Abbott RD Donahue RP MacMahon SW Reed DM Yano K : Diabetes and the risk of stroke: The Honolulu Heart Program JAMA 1987, 257:949–952. ∗ This prospective study showed that diabetes and also high ‘normal’ blood glucose level were significant predictors of thromboembolic stroke, but not of haemorrhagic stroke.

Neaton JD Wentworth DN Cutler J Stamler J Kuller L , for the Multiple Risk Factor Intervention Trial Research Group: Risk factors for death from different types of stroke Ann Epidemiol 1993, 3:493–499. * This large prospective study examined the risk factors for death from stroke among 353 340 screenees of the MRFIT study. It showed that in addition to blood pressure and cigarette smoking, diabetes was significantly associated with death from nonhaemorrhagic stroke.

Stegmayr B Asplund K : Diabetes as a risk factor for stroke: A population perspective Diabetologia 1995, 38:1061–1068. * A Swedish population-based study from the MONICA project showing the association of diabetes with the incidence of strokes in population aged 35-74 years. Approximately 50 strokes per 100 000 persons are directly attributable to diabetes in this population.

Håheim LL Holme I Hjermann I Leren P : Nonfasting serum glucose and the risk of fatal stroke in diabetic and nondiabetic subjects: 18-year follow-up of the Oslo study Stroke 1995, 26:774–777.

Kuusisto J Mykkänen L Pyörälä K Laakso M : Non-insulin-dependent diabetes and its metabolic control are important predictors of stroke in eldery subjects Stroke 1994, 25:1157–1164. ∗ In this study noninsulin-dependent diabetes mellitus increased the risk of stroke during the 3.5-year follow-up. Among diabetic patients poor metabolic control was the most important risk factor for stroke.

Lehto S Rönnemaa T Pyörälä K Laakso M : Predictors of stroke in middle-aged patients with non-insulin dependent diabetes Stroke 1966, 27:63–68.

Barrett-Connor E Khaw KT : Diabetes mellitus: An independent risk factor for stroke? Am J Epidemiol 1988, 128:116–123. ∗ Diabetes increased the risk of stroke independently of blood pressure.

Sprafka JM Virnig BA Shahar E McGovern PG : Trends in diabetes prevalence among stroke patients and the effect of diabetes on stroke survival: The Minnesota Heart Survey Diabetic Med 1994, 11:678–684.

Olsson T Viitanen M Asplund K Eriksson S Hagg E : Prognosis after stroke in diabetic patients. A controlled prospective study Diabetologia 1990, 33:244–249. ∗ Diabetes not only increases the risk of stroke but also increases the risk of mortality, recurrent stroke and myocardial infarction after the initial stroke.

Sivenius J Laakso M Riekkinen P Sr Smets P Löwenthal A : European Stroke Prevention Study: Effectiveness of antiplatelet therapy in diabetic patients in secondary prevention trial Stroke 1992, 23:851–854.

Jørgensen H Nakayama H Raaschou HO Olsen TS : Stroke in patients with diabetes. The Copenhagen Stroke Study Stroke 1994, 25:1977–1984.

Jørgensen HS Nakayama H Raaschou HO Olsen TS : Effect of blood pressure and diabetes on stroke in progression Lancet 1994, 344:156–159.

The Diabetes Control and Complications Trial Research Group: The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus N Engl J Med 1993, 329:977–986. * A landmark study showing the importance of proper metabolic control in the prevention of microvascular diabetic complications and risk factors for macrovascular complications.

The Diabetes Control and Complications Trial Research Group: Effect of intensive diabetes management on macrovascular events and risk factors in the Diabetes Control and Complications Trial Am J Cardiol 1995, 75:894–903.

Melton LJ III Macken KM Palumbo PJ Elveback LR : Incidence and prevalence of clinical peripheral vascular disease in a population-based cohort of diabetic patients Diab Care 1980, 3:650–654.

Siitonen O Uusitupa M Pyörälä K Voutilainen E Länsimies E : Peripheral arterial disease and Its relationship to cardiovascular risk factors and coronary heart disease in newly diagnosed non-insulin-dependent diabetics Acta Med Scand 1986, 220:205–212.

Mykkänen L Laakso M Pyörälä K : Asymptomatic hyperglycemia and atherosclerotic vascular disease in elderly Diab Care 1992, 15:1020–1030.

Beks PJ Mackaay AJ de Neeling JN de Vries H Bouter LM Heine RJ : Peripheral arterial disease in relation to glycaemic level in an elderly Caucasian population: The Hoorn study Diabetologia 1995, 38:86–96. ∗ Parameters of glucose tolerance as well as diabetes are related to peripheral arterial disease. Data supports the beneficial effect of smoking cessation on peripheral arterial disease.

Kreines K Johnson E Albrink M Knetterud GL Levin ME Levitan A et al.: The course of peripheral vascular disease in non-insulin-dependent diabetes Diab Care 1985, 8:235–243.

Abbott RD Brand FN Kannel WB : Epidemiology of some peripheral arterial findings in diabetic men and women: Experiences from the Framingham Study Am J Med 1990, 88:376–381. ∗ Diabetes increases the risk of peripheral arterial disease. In patients with diabetes and peripheral arterial disease the risk of acute cardiovascular events is considerably increased.

Bowlin SJ Medalie JH Flocke SA Zyzanski SJ Goldbourt U : Epidemiology of intermittent claudication in middle-aged men Am J Epidemiol 1994, 140:418–430.

Laakso M Rönnemaa T Pyörälä K Kallio V Puukka P Penttilä I : Atherosclerotic vascular disease and its risk factors in non-insulin-dependent diabetic and nondiabetic subjects in Finland Diab Care 1988, 11:449–463.

Brand FN Abbott RD Kannel WB : Diabetes, intermittent claudication, and risk of cardiovascular events. The Framingham Study Diabetes 1989, 38:504–509. ∗ In this study based on Framingham data, diabetes was related to the increased risk of stroke. The risk is enhanced in diabetic patients with intermittent claudication.

Reiber GE Boyko EJ Smith DG : Lower extremity foot ulcers and amputations in diabetes. In National Diabetes Data Group, ed. Diabetes in America 2nd ed.: National Institutes of Health, 1995:409–428. (NIH Publications; 95-1468).

Humphrey LL Palumbo PJ Butters MA Hallett JV Jr Chu CP O'Fallon VM : The contribution of non-insulin-dependent diabetes to lower-extremity amputation in the community Arch Intern Med 1994, 154:885–892.

Klein R : Hyperglycemia and microvascular and macrovascular disease in diabetes Diab Care 1995, 18:258–268. ∗ Klein's 1994 Kelly West lecture. Excellent summary on the associations between hyperglycaemia and microvascular and macrovascular complications in diabetes.

Pecoraro RE Reiber GE Burgess EM : Pathways to diabetic limb amputations. Basis for prevention Diab Care 1990, 13:513–521.

Folsom AR Eckfeldt JH Weitzman S Ma J Chambless LE Barnes RW et al.: Relation of carotid artery wall thickness to diabetes mellitus, fasting glucose and insulin, body size, and physical activity Stroke 1994, 25:66–73. * This large study examined the relationship of carotid artery wall thickness to several cardiovascular risk factors in 14 430 persons. The results show that diabetes and blood glucose and insulin level are significantly and positively associated with the wall thickness of carotid arteries.

Kawamori R Yamasaki Y Matsushima H Nishizawa H Nao K Hougaku H et al.: Prevalence of carotid atherosclerosis in diabetic patients Diab Care 1992, 15:1290–1294.

Yamasaki Y Kawamori R Matsushima H Nishizawa H Kodama M Kajimoto Y et al.: Atherosclerosis in carotid artery of young IDDM patients monitored by ultrasound high-resolution B-mode imaging Diabetes 1994, 43:634–639. ∗ This Japanese study showed that in patients with insulin-dependent diabetes mellitus even as young as 10-19 years the intima-media thicknesses of carotid arteries were thicker than in age-matched controls. Patients with noninsulin dependent diabetes mellitus had intima-media thickness values equivalent to those observed in normal persons 20 years older.

Laakso M Sarlund H Salonen R Suhonen M Pyörälä K Salonen JT Karhapää P : Asymptomatic atherosclerosis and insulin resistance Arterioscler Thromb 1991, 11:1068–1076. ∗ This study provided the first direct evidence that asymptomatic atherosclerosis is associated with insulin resistance.

Agewall S Fagerberg B Attvall S Wendelhag I Urbanavicius V Wikstrand J : Carotid artery wall intima-media thickness is associated with insulin-mediated glucose disposal in men at high and low coronary risk Stroke 1995, 26:956–960.

Salomaa V Riley W Kark JD Nardo C Folsom AR : Non-insulin-dependent diabetes mellitus and fasting glucose and insulin concentrations are associated with arterial stiffness indexes. The ARIC study Circulation 1995, 91:1432–1443. * This report from the ARIC study demonstrated that fasting glucose and insulin levels are positively associated with the stiffness of the carotid arteries. These associations were independent of the blood pressure level and the thickness of the artery wall.

Neutel JM Smith DHG Graettinger WF Weber MA : Dependency of arterial compliance on circulating neuroendocrine and metabolic factors in normal subjects Am J Cardiol 1992, 69:1340–1344.

Megnien JL Simon A Valensi P Flaud P Merli I Levenson J : Comparative effects of diabetes mellitus and hypertension on physical properties of human large arteries J Am Coll Cardiol 1992, 20:1562–1568.

Ryden Å Länne T Wollmer P Sonesson B Hansen F Sundkvist G : Increased arterial stiffness in women, but not in men, with IDDM Diabetologia 1995, 38:1082–1089.

Kupari M Hekali P Keto P Poutanen V-P Tikkanen MJ Standertskjold- Nordenstam CG : Relation of aortic stiffness to factors modifying the risk of atherosclerosis in healthy people Arterioscler Thromb 1994, 14:386–394. ∗ This study used magnetic resonance imaging to examine the stiffness of thoracic aorta and found a positive association between the elastic modulus and serum insulin.

Kannel WB D'Agostino RB Wilson PWF Belanger AJ Gagnon DR : Diabetes, fibrinogen, and risk of cardiovascular disease: The Framingham experience Am Heart J 1990, 120:672–676.

Carmassi F Morale M Puccetti R De Negri F Monzani F Navalesi R Mariani G : Coagulation and fibrinolytic system impairment in insulin dependent diabetes mellitus Thromb Res 1992, 67:643–654.

Barker DJ Hales CN Fall CHD Osmond C Phipps K Clark PMS : Type 2 (non-insulin-dependent) diabetes mellitus, hypertension and hyperlipidaemia (syndrome X): Relation to reduced fetal growth Diabetologia 1993, 36:62–67.

Hales CN Barker DJ : Type 2 (non-insulin-dependent) diabetes mellitus: The thrifty phenotype hypothesis Diabetologia 1992, 35:595–601.

Snowden C Houlston R Laker MF Kesteven P Alberti KGMM Humphries SE : Plasma fibrinogen levels and fibrinogen genotype in non-insulin dependent diabetics Dis Markers 1992, 10:159–168.

Ruiz J Blanche H James RW Blatter Garin M-C Vaisse C Charpentier G : Gin-Arg 192 polymorphism of paraoxonase and coronary heart disease in type 2 diabetes Lancet 1995, 346:869–872.

Wick U Witt E Engel W : Restriction fragment length polymorphisms at the apoprotein genes AI, CIII and B-100 and in the 5′ flanking region of the insulin gene as possible markers of coronary heart disease Clin Genetics 1995, 47:184–190.

Stamler J Vaccaro O Neaton JD Wentworth D , for the Multiple Risk Factor Intervention Trial research group: Diabetes, other risk factors, and 12-year cardiovascular mortality for men screened in the multiple risk factor intervention trial Diabetes Care 1993, 16:434–444. * This large prospective study showed that cholesterol, blood pressure and cigarette smoking were significant predictors of cardiovascular deaths in diabetic as well as in nondiabetic persons. The finding has important implications for the prevention of cardiovascular deaths in diabetic persons.