Management of CAD in Diabetes

8/12/2019 Management of CAD in Diabetes

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Dr.


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Coronary artery disease accounts for more than80% of all deaths and 75% of all

hospitalizations in diabetic subjects.

Circulation. 2000;102(9):1014

9.Acta Diabetol. 2002;39 Suppl 2:228.


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Mohan et al , J Am Coll Cardiol. 2001;38(3):682

7.


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Higher mean Intimal MediaThickness Values .

20% of diabetics had carotidatherosclerosis compared to 1% non-diabetics

Mohan et al , Chennai Urban Population Study (CUPS). Diabetologia.2000;43(4):4949.


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Reduced Endothelial function . Higher arterial stiffness.

Ravikumar et al , Am J Cardiol. 2002;90(7):7027.


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The identified risk factors for CAD include aging,smoking, and a family history of CAD. Type 2diabetes is a part of the insulin resistance cluster

or metabolic syndrome, which is a combinationof hyperglycemia, central body obesity,dyslipidemia, and hypertension .

Each of these can contribute independently to theCAD risk or may cluster to increase the risk. Indian J Endocrinol Metab. 2005;7:7285.


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.....a strong association ofplasma glucose levels with

CAD which also meansthat in Indians, as shownin the West, the clock forCAD starts ticking even

at the IGT stage itself. CUPS study


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Projections for the whole of India would be62.4 million people with diabetes and 77.2

million people with pre-diabetes [2011].

Anjana et al ,Diabetologia. 2011 Dec;54(12):3022-7


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Mohan et al , Chennai Urban Population Study (CUPS). Diabetologia. 2000;43(4):4949.


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Diabetes Prevalence : 34.7 , Hypertension Prevalence : 46.0 . Diabetes and Hypertension : 20.6

SITE StudyJoshi et al ,Diabetes Technol Ther. 2012 Jan;14(1):8-15


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Young Hypertensives patients under the age of 40 have increased from 10percent a decade ago to 30 percent today

Atul Mathur, director of Invasive Cardiology at Fortis Escorts Heart institute

Low prevalence of multiple cardiovascular risk factors(smoking, hypertension, dyslipidemias, diabetes and metabolicsyndrome) in adolescents and rapid escalation of these riskfactors by age of 3039 years is noted in urban Asian Indians .

BMC Cardiovascular Disorders 2009 9:28


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.data suggests thatin Asian Indians, smalldense LDL is associated

with both diabetes andCAD .

Chennai Rural Epidemiology Study(CURES 8). J Assoc Physicians India.

2005;53:95100.


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.Indians have insulin resistance andadiposity even at birth when compared to

Caucasians.

Yajnik et al , J Clin Endocrinol Metab. 2002;87(12):557580.


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Fibrinolytic factors Lipoprotein[a]

Homocysteine Inflammatory markersTNF-, C-reactive

Protein , Endothelin -1 ,V-CAM etc.


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A multifactorial approach by good controlof blood glucose, blood pressure, and serum

lipids appears to be necessary to preventCAD in diabetes patients .

.Lancet. 2001;357(9260):90510.

N Engl J Med. 2003;348(5):38393.


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Dietary Modification. Regular Physical Activity.

Weight Reduction. Cessation of Smoking. Stress Reduction.


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Lifestyle modification in the form of diet andregular moderate exercise sharply decreases

the likelihood of developing type 2 diabetes inhigh-risk individuals who have impairedglucose tolerance or impaired fasting glucose.

The effectiveness of this interventionsuperseded that of metformin therapy.


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..Carbohydrate and monounsaturated fat shouldcomprise 60-70% of total calories.

.studies suggest that the protein requirements forpeople with type 2 diabetes may be slightly greater thanthose for nondiabetic individuals

..people with diabetes should strive to keep saturated fat

consumption to < 7% of total daily calories and tominimize consumption of trans-fatty acids. Cholesterolconsumption should be < 200 mg/day.

Clinical DiabetesJuly 2007vol. 25 no. 3 105-109


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For every kilogram of weight loss, therewas a 16% reduction in risk, adjusted for

changes in diet and activity..Lower percent of calories from fat andincreased physical activity predictedweight loss.

..Increased physical activity wasimportant to help sustain weight loss.

Diabetes Care 29:21022107, 2006


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Nutrient concerns of Vegetariandiets

..nutrients of concern in the diet of

vegetarians include vitamin B(12), vitamin D,-3 fatty acids, calcium, iron, and zinc

Craig et al , Nutr Clin Pract. 2010 Dec;25(6):613-20

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patientswith better adherence to exercise anddiet [ 400 g/day of Fruits, vegetables andlegumes ] showed greater reduction in central

obesity andgreater decline in cardiacevent rates and total mortality

Singh et al , J Am Coll Nutr. 1996 Dec;15(6):592-601.

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Harvard Alumni Study documented that physical inactivityplays a role in CAD

BMJ. 2003;326(7404):1419...subjects who performed

light-grade activity hadincreased prevalence of not onlyCAD but also all cardiovascularrisk factors compared to subjects

who performed heavy-gradeactivity

Chennai UrbanPopulation Study (CUPS no. 15).

Diabet Med. 2005;22(9): 120611.


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A comprehensive surveillance system of riskfactors

and CAD will be an invaluable public health

research tool for monitoring population healthstatus, guiding resource allocation and policy,identifying and prioritizing interventions forsubpopulations at particular risk, identifying

disparities in outcomes, and planningand evaluating health programs.J Diabetes Sci Technol Vol 4, Issue 1, January 2010


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Management of CAD in Diabetes

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