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Cardiovascular disease and Type 2 Diabetes PowerPoint Presentation

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Description : Check out this medical presentation on Atherosclerosis, which is titled "Cardiovascular disease and Type 2 Diabetes", to know about coronary heart disease (CHD), cardiovascular disease (CVD), myocardial infarction (MI), and type 2 diabetes (T2D).

Tags : Atherosclerosis, Cardiovascular disease, Type 2 Diabetes

Published on : Jun 02, 2021 | Views : 3285 | Downloads : 30

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EDUCATIONAL SLIDE MODULES Module A: Cardiovascular disease and Type 2 Diabetes Date of preparation: August 2015
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ACROSS T2D educational slide modules 2
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CVD is a significant global burden 5 1. WHO. CVD Fact sheet N°317, Jan 2015. http://www.who.int/mediacentre/factsheets/fs317/en/#. 7.4 million due to CHD 6.7 million due to stroke Total global deaths in 2012 ~56 million1
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Represents 2 million people. Diabetes is mostly (85–95%) T2D.1 T2D approximately doubles the risk of death2 Diabetes caused 4.9 million deaths in 20141 CVD is the principal cause of death in T2D2,3 1.76 1.85 1 1.5 2.0 T2D is increasingly prevalent and CVD is the leading cause of death in this population 6 1. IDF Diabetes Atlas, 2014. 6th Edition. http://www.idf.org/diabetesatlas. 2. Nwaneri et al. Br J Diabetes Vasc Dis 2013;13:192–207. 3. Morrish et al. Diabetologia 2001;44(suppl 2):S14–21. Globally, 387 million people are living with diabetes1 Rising to 592 million by 20351 Relative risk for all-cause mortality Relative risk for CV mortality
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Key manifestations of CV disease 8 1. World Health Organization 2015: http://www.who.int/cardiovascular_diseases/en/cvd_atlas_01_types.pdf?ua=1 2. http://www.heart.org/HEARTORG/Caregiver/Resources/WhatisCardiovascularDisease/What-is-Cardiovascular-Disease_UCM_301852_Article.jsp# Peripheral arterial disease Disease of blood vessels supplying arms and legs1 Coronary heart disease Disease of blood vessels supplying heart muscle1 Stroke Caused by disruption of blood supply to the brain1 Heart failure Failure of the heart to pump blood with normal efficiency (sometimes called congestive heart failure)2
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T2D is a major and independent risk factor for both microvascular and macrovascular complications 9 1. World Health Organization. http://www.who.int/diabetes/action_online/basics/en/index3.html Macrovascular Microvascular
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Endothelial dysfunction is common to microvascular and macrovascular events 10 Versari et al. Diabetes Care 2009;32(suppl 2):S314-321. 10
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Endothelial dysfunction drives atherosclerotic progression 11 Figure adapted from Libby. Circulation 2001;104:365‒72. Zeadin et al. Can J Diabetes 2013;37:345e350. Atherosclerosis is accelerated in T2D by hyperglycaemia, insulin resistance, inflammation and diabetic dyslipidaemia
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Visceral adiposity is related to inflammation, insulin resistance, dyslipidaemia and atherosclerosis 12 *including: TNFα, IL-6, resistin, PAI-1, angiotensinogen Lau et al. Am J Physiol Heart Circ Physiol 2005;288:H2031‒41. OBESITY  Adiponectin Adipocytokines  inflammatory cytokines* T2D Insulin resistance Dyslipidaemia Endothelial dysfunction Hypertension Age  Oxidative stress  Atherosclerosis Interactions are complex, inter-related and not necessarily causal
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Burden and pathophysiology of CVD and T2D CVD is a significant cause of morbidity and mortality globally and is the leading cause of death in people with T2D1-4 T2D is a major independent risk factor for CVD5 Endothelial dysfunction:6 Affects microvascular and macrovascular risk Drives atherosclerosis Atherosclerosis is accelerated in patients with T2D7,8 Visceral adiposity is associated with increased insulin resistance, inflammation and atherogenic dyslipidaemia9 13 1. http://www.who.int/mediacentre/factsheets/fs317/en/#. 2. http://www.idf.org/diabetesatlas. 3. Nwaneri et al. Br J Diabetes Vasc Dis 2013;13:192–207. 4. Morrish et al. Diabetologia 2001;44 Suppl 2:S14–21. 5. http://www.who.int/diabetes/action_online/basics/en/index3.html. 6. Versari D, et al. Diabetes Care. 2009;32(Suppl 2):S314-321. 7. Libby P. Circulation. 2001;104:365-372. 8. Zeadin, et al. Can J Diabetes. 2013;37:345e350. 9. Lau et al. Am J Physiol Heart Circ Physiol 2005;288:H2031-H2041.
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Coronary heart disease Coronary death Non-fatal MI Cerebrovascular disease Ischaemic stroke Haemorrhagic stroke Unclassified stroke Other vascular deaths 2.00 (1.83–2.19) 2.31 (2.05–2.60) 1.82 (1.64–2.03) 2.27 (1.95–2.65) 1.56 (1.19–2.05) 1.84 (1.59–2.13) 1.73 (1.51–1.98) HR (95% CI) 26,505 11,556 14,741 3799 1183 4973 3826 Number of cases 1 1 2 4 Hazard ratio (diabetes vs no diabetes) Outcome Diabetes doubles the risk of vascular events Sarwar et al. Lancet 2010;375(9733):2215–2222. 15 2
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Diabetes is associated with significant loss of life years 16 Seshasai et al. N Engl J Med 2011;364:829-41. 0 7 6 5 4 3 2 1 0 40 50 60 70 80 90 Age (year) Years of life lost Men 7 6 5 4 3 2 1 0 40 50 60 70 80 90 0 Age (year) Women Non-vascular deaths Vascular deaths On average, a 50-year old with diabetes but no history of vascular disease is ~6 years younger at time of death than a counterpart without diabetes
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Life expectancy is reduced by multiple morbidities of diabetes, stroke and MI 17 Adapted from Danesh et al. for ERFC JAMA 2015;314:52–60. Age- and sex-adjusted HRs for mortality by baseline disease status 1 2 4 8 16 Hazard ratio (95% CI)
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Diabetes confers significant CV risk; combination of diabetes and history of MI further increases risk 18 Schramm et al. Circulation 2008;117:1945–54. CV mortality event rate/1000 person-years 250 200 150 100 50 0 30–39 40–49 50–59 60–69 70–79 80–89 Age Men Women 250 200 150 100 50 0 30–39 40–49 50–59 60–69 70–79 80–89 Age No diabetes, no prior MI Diabetes Prior MI Diabetes + prior MI
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Diabetes-related CV complications have declined with improved care, but substantial burden remains 19 Adapted from Gregg et al. N Engl J Med 2014;370:1514‒23. Years
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Renal disease is associated with increased all-cause mortality 20 *Includes participants with or without diabetes and chronic kidney disease. Tonelli et al. Lancet 2012;380(9844):807–14. 75 60 45 15 0 Rates (per 1000 person-years) Previous MI* Diabetes and CKD CKD (eGFR <60 mL/min per 1.73 m2) Diabetes No diabetes or CKD 30 All-cause mortality
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T2D increases CV risk Diabetes doubles the risk of vascular events, and reduces life expectancy1,2 Risk is further increased in patients with T2D and CVD3,4 Incidence of T2D-related CV complications have declined with improved standard of care5 However, rates remain higher than in adults with no diabetes and rising incidence of T2D will increase overall burden Combination of T2D and renal disease further increases CV risk6 21 Section recap 1. Sarwar et al. Lancet. 2010;375(9733):2215–2222. 2. Seshasai et al. N Engl J Med 2011;364:829-41. 3. Haffner SM, et al. N Engl J Med. 1998;339:229–234. 4. Schramm TK, et al. Circulation. 2008;117:1945–1954. 5. Gregg EW, et al. N Engl J Med. 2014;370:1514-1523. 6. Tonelli M et al. Lancet 2012.;380(9844):807–814.
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Modifiable CV risk factors are common in patients with T2D1,2 Hyperglycaemia Hypertension Dyslipidaemia Obesity 23 Almost a third of diabetes patients were current smokers2 1. Svensson et al. Diab Vasc Dis Res 2013;10:520–9. 2. Das et al. Am Heart J 2006;151:1087–93.
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CV death is increased in patients with diabetes and multiple risk factors 24 Risk factors were serum cholesterol ≥200 mg/dL, current smoker, SBP ≥120 mmHg Stamler et al. Diabetes Care 1993;16:434.
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Dysglycaemia is an independent risk factor for adverse CV outcomes 25 1. Sarwar et al. Lancet 2010;375:2215–22. 2. Seshasai et al. N Engl J Med 2011;364:829–41. Vascular death2 Coronary heart disease1
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Hypertension: each 20/10 mmHg BP increase doubles the risk of CV mortality 26 Population of 1 million adults with no previous vascular disease recorded at baseline in 61 prospective observational studies of blood pressure and mortality Lewington et al. Lancet 2002;360:1903–13. 135/85 155/95 175/105 Fold increase in relative CV risk 115/75 SBP/DBP mmHg
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Dyslipidaemia: increased LDL-C increases risk of CHD 27 Grundy et al. Arterioscler Thromb Vasc Biol 2004;24:e149-e161. 40 70 100 130 160 190 1.0 1.3 1.7 2.2 2.9 3.7 Relative risk for CHD (log scale) LDL-C (mg/dL)
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Dyslipidaemia: increased LDL-C and decreased HDL-C are associated with raised risk of CHD 28 Taylor. Eur Heart J Suppl 2006;8:F74–80. 3.0 2.0 1.0 0.0 100 160 220 85 65 45 25 LDL-C (mg/dL) HDL-C (mg/dL) Relative risk of CHD
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Abdominal obesity is associated with increased risk of both diabetes and CVD 29 Population of 168,000 primary care patients across 63 countries Balkau et al. Circulation 2007;116:1942–51. 20 15 10 5 0 <84 ≥84–<92 ≥92–<99 ≥99–<107 ≥107 Waist circumference (cm) Frequency (%) CVD Diabetes Men
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Additional risk factors in T2D Modifiable CV risk factors are common in patients with T2D1,2 CV mortality is higher in patients with T2D and multiple risk factors Hyperglycaemia is associated with a non-linear increase in risk of CV events and mortality3,4 Hypertension leads to a non-linear increase in mortality5 Increased LDL leads to a non-linear increase in risk of CHD6,7 Visceral obesity is associated with increased risk of both diabetes and CVD8 30 Section recap 1. Svensson et al. Diab Vasc Dis Res 2013;10:520–9. 2. Das et al. Am Heart J 2006;151:1087–93. 3. Sarwar et al. Lancet. 2010;375:2215–2222. 4. Seshasai et al. N Engl J Med. 2011;364:829–841. 5. Lewington S, et al. Lancet. 2002;360:1903–1913. 6. Grundy et al. Arteriosclerosis, Thrombosis, and Vascular Biology. 2004;24:e149-e161. 7. Taylor AJ. European Heart Journal. Supplement 2006;8:F74–80. 8. Balkau B, et al. Circulation. 2007;116:1942–1951. .
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Summary T2D is a major independent risk factor for CVD1 Endothelial dysfunction and progression of atherosclerosis is accelerated in patients with T2D2,3 Patients with T2D are at significantly increased CV risk4 Additional risk factors associated with T2D4-9 Hypertension, dyslipidaemia, visceral adiposity, hyperglycaemia and renal dysfunction are all associated with further increasing CV risk 31 1. World Health Organization. http://www.who.int/diabetes/action_online/basics/en/index3.html. 2. Libby P. Circulation. 2001;104:365-372. 3. Zeadin, et al. Can J Diabetes. 2013;37:345e350. 4. Sarwar et al. Lancet. 2010;375(9733):2215–2222. 5. Seshasai et al. N Engl J Med. 2011;364:829–841. 6. Lewington S, et al. Lancet. 2002;360:1903–1913. 7. Grundy et al. Arteriosclerosis, Thrombosis, and Vascular Biology. 2004;24:e149-e161. 8. Taylor AJ. European Heart Journal. Supplement 2006;8:F74–80. 9. Balkau B, et al. Circulation. 2007;116:1942–1951.
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Diabetes confers significant CV risk; the combination of diabetes and history of MI further increases risk 32 P<0.001 for all subjects for prior MI vs. no prior MI, and for diabetes vs. no diabetes Haffner et al. N Engl J Med 1998;339:229–34. Incidence of CV events (%) No diabetes, no prior MI Diabetes Prior MI Diabetes + prior MI
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Whether presence of diabetes and a prior MI confer equivalent CV risk is not supported by all analyses 33 Bulugahapitiya et al. Diabet Med 2009;26:142–48. 0.2 0.5 1 1.5 2 Favours diabetes as not a CHD risk equivalent Favours diabetes as a CHD risk equivalent