Rimsha Ismail
Lahore University of Management Sciences, Pakistan
Scientific Tracks Abstracts: Jour Diab Meta
Cardiovascular diseases are the most prevalent cause of illness and mortality among patients with Type 1 or Type 2 diabetes. The proposed mechanisms that can link enhanced atherosclerosis and increased cardiovascular risk in our society are poorly understood. It has been suggested that an association between hypo/hyper glycemia and intracellular metabolic changes can result in oxidative stress(a disturbance in the balance between the production of reactive oxygen species (free radicals) and antioxidant defenses, is discussed in relation to its possible role in the production of tissue damage in diabetes mellitus), low-grade inflammation, and endothelial dysfunction (in which the endothelial layer of the small arteries fails to perform all of its important functions normally. As a result, several bad things can happen to the tissues supplied by those arteries). The impact of clinical factors that may coexist with diabetes such as obesity, dyslipidemia, and hypertension are also discussed. Keywords: Obesity; Dyslipidemia; Hypertension, Type 1 or Type 2 diabetes Introduction: Diabetes is an important chronic disease which incidence is globally increasing and though considered as an epidemic. Individuals with diabetes and with chronically poor metabolic control can experience micro-vascular and macro vascular complications. Cardiovascular Diseases (CVD) are the most prevalent cause of mortality and morbidity among people with T2D and T1D. Adult people with diabetes present rates of mortality due to heart disease and stroke from two to four times higher than those without diabetes (Figure 1). Pathogenesis of cardiovascular disease in diabetes. The mechanisms involved in the pathogenesis of cardiovascular disease in diabetes comprehend epigenetic changes and intracellular metabolic changes that result in oxidative stress, low-grade inflammation, and endothelial dysfunction. CRP: Creactive protein; FFA: free fatty acids; INOS: inducible nitric oxide synthase; IL-1: interleukin 1; IL-6: interleukin 6; MCP 1: monocyte chemo attractant molecule 1; MMP: matrix metalloproteinase; NF-κB: nuclear factor kappa-β; PAI-1: plasminogen activator inhibitor-1; VCAM-1; vascular cell adhesion molecule-1; VEFG: vascular endothelial growth factor; TNF-α: Tumor necrosis factor-α; INF-γ: Interferon-γ. Obesity: Obesity, which prevalence is also increasing worldwide is becoming a major public health issue due to its association with chronic diseases such as diabetes mellitus, hypertension, dyslipidemia, sleep apnea, osteoarticular disease, and cardio and cerebrovascular diseases. Obesity, especially with visceral fat deposition, is associated with low-grade inflammation, which plays a role in the pathogenesis of diabetes, and both diseases are associated with significant increase in morbidity and mortality due to cardio vascular disease. Dyslipidemia: Dyslipidemia in T2D worsens cardiovascular risk due to the peculiar atherogenic profile composed by increased Very LowDensity Lipoprotein (VLDL) cholesterol, triglycerides and small and dense LDL cholesterol levels and decreased High-Density Lipoprotein (HDL) cholesterol levels Hypertension: Hypertension is a highly prevalent disease worldwide and very common among patients with diabetes. Approximately from 10 to 30% of T1D and 60% of T2D (According to sources) patients have hypertension. The coexistence of these two conditions increases the risk of developing macro-vascular complications (myocardial infarction, stroke) and also micro-vascular complications. Oxidative stress: Increased intracellular glucose concentrations result in the activation of alternative pathways of metabolism such as the hexosamine and the aldose reductase pathways, both involved in the pathophysiology of chronic complications of diabetes.
Conclusion: The incidence of diabetes is sharply increasing worldwide which represents an important burden for patients and for the society as well due to micro- and macro vascular complications that people with this condition may experience and consequently cardiovascular diseases that are the most prevalent causes of morbidity and mortality among patients with diabetes. The classical risk factors for the development of cardio vascular disease in subjects with diabetes are the presence of poor glycemic control, obesity, dyslipidemia, and hypertension. In recent decades, several clinical trials have investigated the effect of intensive treatment of hyperglycemia on cardiovascular risk reduction, in both T1D and T2D
