Medical Management of Diabetes and Heart Disease PDF

Preface

Development of this book was stimulated by three sobering facts. First, more than 16 million people in the United States alone are afflicted with diabetes, the large majority with type 2 diabetes. Second, mortality attributable to cancer, heart disease unassociated with diabetes, and stroke has declined markedly since 1980, whereas that associated with diabetes has climbed considerably. Third, coronary disease is the major cause of death in people with diabetes and, in contrast to microangiopathy, progression of macrovascular disease is retarded only modestly by stringent glycemic control. Unfortunately, many still believe that diabetes is simply hyperglycemia, and advances in understanding the pivotal role of insulin resistance in type 2 diabetes are often overlooked. If we are to diminish cardiovascular morbidity and mortality associated with diabetes, we must recognize that, whether covert or overt, diabetes is tantamount to coronary disease. Without early and vigilant interventions by physicians, diabetes will continue to spawn acute coronary syndromes and their enormous toll.

This book was developed to underscore the intimate relationship between diabetes and heart disease, to emphasize targets for prevention and treatment of cardiac manifestations, and to elucidate pathophysiological links that constitute such targets. It is included in the Medical Management program, which is dedicated to providing medical practitioners, whether generalists or specialists, with current and comprehensive information pertinent to the care of patients in a fashion akin to a clinical consultation.

Causal connections between diabetes and heart disease are the editors' point of departure. Chapter 2 discusses different types of diabetes and their implications regarding heart disease. Chapter 3 addresses recognition, assessment, and management of insulin resistance. Relationships between hypertension, diabetes, and the heart are the subject of Chapter 4, and the relationships between hyperlipidemia, diabetes, and the heart are described in Chapter 5. Chapter 6 focuses on derangements in coagulation and fibrinolysis associated with diabetes and their pathogenetic implications regarding coronary disease. Chapter 7 elegantly elucidates the metabolic syndrome of insulin resistance, and Chapter 8 covers its deteciiition and diagnosis. Because the polycystic ovarian syndrome is a syndrome of insulin resistance, its nature and predisposition to coronary disease are considered in Chapter 9. Heart disease associated with diabetes is not confined to coronary disease. Chapter 10 explores cardiomyopathic consequences and their recognition.

Finally, Chapters 11 to 16 deal with prevention and treatment of heart disease in patients with diabetes. Chapter 11 focuses on amelioration of insulin resistance. Chapter 12 discusses treatment of coronary disease in patients with diabetes. Congestive heart failure is covered in Chapter 13, and coronary interventions and surgery are the topics of Chapter 14. Chapter 15 is concerned with nutritional and nonpharmacological reduction of cardiovascular risk.

The armamentarium for retarding progression of heart disease and treating it more effectively is expanding rapidly. Additional opportunities will undoubtedly arise from novel research, some of which we review in Chapter 16.

We are grateful for the authoritative, cogent, and comprehensive contributions from genuine leaders in their fields. We know our readers will benefit from their efforts and expertise.