Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
030.12.047
Trisakti University
2013
preface
Thanks to Allah SWT, because due his grace I can finish my paper with the title "Correlation between
diabetes and Coronary artery Disease." On time and without any material issues.
This paper is made to suit the requirement of passing english 2 Trisakti university faculty of medicine,
Hopefully this article can be useful for readers, especially for other medical students at other universities.
Author definitely needs to be developed criticisms and suggestions to the author peper in the future to get
better.
Heart health should always be a concern, but for people with diabetes, it is extremely important.
Diabetes is a disorder in which your body doesn’t produce or process insulin correctly and is often
directly connected to Coronary artery disease. In fact, a person with diabetes has twice the chance of
developing heart disease as someone without this condition. In the world, there were so many people that
killed by heart disease. People with diabetes didn’t know what exactly cause of Coronary artery can
happen to them
Introduction
The connection between diabetes and Coronary artery disease starts with high blood glucose
(sugar) levels. With time, the high glucose in the bloodstream damages the arteries, causing them to
become stiff and hard. Fatty material that builds up on the inside of these blood vessels can eventually
block blood flow to the heart or brain, leading to heart attack or stroke.
Individuals with insulin resistance or diabetes in combination with one or more of these risk
factors are more likely to fall victim to Coronary artery disease. However, by controlling these risk
factors, diabetes patients may avoid or delay the development of heart and blood vessel disease.
Diabetes mellitus
Definition
Disbetes is a group of metabolic diseases in which a person has high blood sugar, either because
the pancreas does not produce enough insulin, or because cells do not respond to the insulin that is
produced. This high blood sugar produces the classical symptoms of polyuria (frequent urination),
Type 1 DM results from the body's failure to produce insulin, and currently requires the person to
inject insulin or wear an insulin pump. This form was previously referred to as "insulin-dependent
Type 2 DM results from insulin resistance, a condition in which cells fail to use insulin properly,
sometimes combined with an absolute insulin deficiency. This form was previously referred to as
type 1 diabetes mellitus is characterized by loss of the insulin-producing beta cells of the islets of
Langerhans in the pancreas, leading to insulin deficiency. This type can be further classified as immune-
mediated or idiopathic. The majority of type 1 diabetes is of the immune-mediated nature, in which beta
cell loss is a T-cell-mediated autoimmune attack. There is no known preventive measure against type 1
diabetes, which causes approximately 10% of diabetes mellitus cases in North America and Europe. Most
affected people are otherwise healthy and of a healthy weight when onset occurs. Sensitivity and
"Brittle" diabetes, also known as unstable diabetes or labile diabetes, is a term that was
traditionally used to describe to dramatic and recurrent swings in glucose levels, often occurring for no
apparent reason in insulin-dependent diabetes. This term, however, has no biologic basis and should not
be used. There are many reasons for type 1 diabetes to be accompanied by irregular and unpredictable
hyperglycemias, frequently with ketosis, and sometimes serious hypoglycemias, including an impaired
absorption of dietary carbohydrates), and endocrinopathies (e.g., Addison's disease). These phenomena
are believed to occur no more frequently than in 1% to 2% of persons with type 1 diabetes.
Type 2 diabetes mellitus is characterized by insulin resistance, which may be combined with
relatively reduced insulin secretion. The defective responsiveness of body tissues to insulin is believed to
involve the insulin receptor. However, the specific defects are not known. Diabetes mellitus cases due to a
known defect are classified separately. Type 2 diabetes is the most common type.
In the early stage of type 2, the predominant abnormality is reduced insulin sensitivity. At this
stage, hyperglycemia can be reversed by a variety of measures and medications that improve insulin
Symptoms
The classic symptoms of untreated diabetes are loss of weight, polyuria (frequent urination),
polydipsia (increased thirst) and polyphagia (increased hunger). Symptoms may develop rapidly (weeks
or months) in type 1 diabetes, while they usually develop much more slowly and may be subtle or absent
in type 2 diabetes.
Prolonged high blood glucose can cause glucose absorption in the lens of the eye, which leads to
changes in its shape, resulting in vision changes. Blurred vision is a common complaint leading to a
diabetes diagnosis. A number of skin rashes that can occur in diabetes are collectively known as diabetic
dermadromes.
Causes
Genetic, Heredity plays an important part in determining who is likely to develop diabetes
Autoimmune Destruction of Beta Cells, white blood cells called T cells attack and destroy beta
cells. The process begins well before diabetes symptoms appear and continues after diagnosis.
Often, type 1 diabetes is not diagnosed until most beta cells have already been destroyed. At this
point, a person needs daily insulin treatment to survive. Finding ways to modify or stop this
autoimmune process and preserve beta cell function is a major focus of current scientific
research.
Recent research suggests insulin itself may be a key trigger of the immune attack on beta cells.
The immune systems of people who are susceptible to developing type 1 diabetes respond to
insulin as if it were a foreign substance, or antigen. To combat antigens, the body makes proteins
called antibodies. Antibodies to insulin and other proteins produced by beta cells are found in
people with type 1 diabetes.
Environmental
Obesity
Insulin Resistance, Insulin resistance is a common condition in people who are overweight or
obese, have excess abdominal fat, and are not physically active. Muscle, fat, and liver cells stop
responding properly to insulin, forcing the pancreas to compensate by producing extra insulin. As
long as beta cells are able to produce enough insulin, blood glucose levels stay in the normal
range. But when insulin production falters because of beta cell dysfunction, glucose levels rise,
leading to prediabetes or diabetes.
Treatment
The main goal of diabetes mellitus treatment is to try to normalize the activity of insulin and
blood glucose levels in an attempt to reduce vascular complications as well as therapeutic
neuropati.Tujuan on any type of diabetes is to achieve normal blood glucose levels.
Complication
Acute
Hypoglikemia, Symptomatic hypoglycemia reaction is caused by the body lacks glucose,
dengantanda Symptoms: hunger, trembling, cold sweat, dizziness. If this condition is not
segeradiobati, patients may be comatose. Because coma in patients due to the lack of glucose in
the blood, then the commas called "hypoglycemic coma".
Chronic
Diabetic retinopathy, which is damage to the eye such as cataracts and glaucoma or
increased pressure in the eyeball. Form of damage is the most common form of retinopathy that
Diabetic nephropathy, the renal impairment caused by diabetic patients in a long time.
Prevention
The same lifestyle habits that can help treat diabetes disease can also help prevent it from
developing in the first place. Leading a healthy lifestyle can help keep your blood sugar. To improve your
Definition
Coronary artery disease develops when your coronary arteries the major blood vessels that
supply your heart with blood, oxygen and nutrients become damaged or diseased. Cholesterol-
containing deposits (plaque) on your arteries are usually to blame for coronary artery disease.
When plaques build up, they narrow your coronary arteries, causing your heart to receive less blood.
Eventually, the decreased blood flow may cause chest pain (angina), shortness of breath, or other
coronary artery disease signs and symptoms. A complete blockage can cause a heart attack.
Because coronary artery disease often develops over decades, it can go virtually unnoticed until
Epidemiology
Cerebro Vascular Disease encompasses not only CAD but also cerebrovascular disease,
peripheral arterial disease as well as other cardiac disorders, and is currently the leading cause of death in
the world, particularly amongst women. The World Health Organisation (WHO) estimates that such
diseases caused almost 32% of all deaths in women and 27% in men in 2004 (World Health Organisation
[WHO], 2008). CAD is the most common cause of CVD deaths (45% of all CVD deaths) accounting for
7.2 million deaths/year, or 12% of all deaths worldwide (Figure 2). In many developed countries, CAD is
the single leading cause of death. In the United Kingdom (UK) in 2008, CAD was responsible for about
one in five male deaths and one in eight female deaths; a total of 88,000 CAD deaths (15% of total
deaths) (British Heart Foundation [BHF], 2010). Similarly in the United States in 2005, CAD was
responsible for one of every five deaths, accounting for 445,687 deaths (18% of total deaths) (Lloyd-
Jones et al, 2009). In Australia in 2006, CAD accounted for 22,983 deaths (17% of all deaths) and once
more was the most common condition responsible for Australian deaths (Australian Institute of Health
Coronary artery disease is thought to begin with damage or injury to the inner layer of a
Smoking
High cholesterol
Diabetes
Pathology
Once the inner wall of an artery is damaged, fatty deposits (plaques) made of cholesterol and
other cellular waste products tend to accumulate at the site of injury in a process called atherosclerosis.
If the surface of these plaques breaks or ruptures, blood cells called platelets will clump at the site to try
to repair the artery. This clump can block the artery, leading to a heart attack
Diagnosis
The doctor will ask questions about your medical history, do a physical exam and order routine
blood tests. Doctor may suggest one or more diagnostic tests as well, including:
through your heart. An ECG can often reveal evidence of a previous heart attack or one that's
in progress. In other cases, Holter monitoring may be recommended. With this type of ECG,
you wear a portable monitor for 24 hours as you go about your normal activities. Certain
During an echocardiogram, your doctor can determine whether all parts of the heart wall are
contributing normally to your heart's pumping activity. Parts that move weakly may have
been damaged during a heart attack or be receiving too little oxygen. This may indicate
Cardiac catheterization or angiogram. To view blood flow through your heart, your doctor
may inject a special dye into your arteries (intravenously). This is known as an angiogram.
The dye is injected into the arteries of the heart through a long, thin, flexible tube (catheter)
that is threaded through an artery, usually in the leg, to the arteries in the heart. This
procedure is called cardiac catheterization. The dye outlines narrow spots and blockages on
the X-ray images. If you have a blockage that requires treatment, a balloon can be pushed
through the catheter and inflated to improve the blood flow in your coronary arteries. A mesh
tube (stent) may then be used to keep the dilated artery open.
tomography (EBCT) or a CT coronary angiogram, can help your doctor visualize your
arteries. EBCT, also called an ultrafast CT scan, can detect calcium within fatty deposits that
disease may be likely. A CT coronary angiogram, in which you receive a contrast dye
injected intravenously during a CT scan, also can generate images of your heart arteries.
Magnetic resonance angiography (MRA). This procedure uses MRI technology, often
combined with an injected contrast dye, to check for areas of narrowing or blockages
although the details may not be as clear as those provided by coronary catheterization
Treatment
o Drugs
drugs decrease the primary material that deposits on the coronary arteries. Boosting
your high-density lipoprotein (HDL, or the "good") cholesterol may help, too. Your
doctor can choose from a range of medications, including statins, niacin, fibrates and
Aspirin. Your doctor may recommend taking a daily aspirin or other blood thinner.
This can reduce the tendency of your blood to clot, which may help prevent
obstruction of your coronary arteries. If you've had a heart attack, aspirin can help
prevent future attacks. There are some cases where aspirin isn't appropriate, such as
if you have a bleeding disorder or you're already taking another blood thinner, so ask
Beta blockers. These drugs slow your heart rate and decrease your blood pressure,
which decreases your heart's demand for oxygen. If you've had a heart attack, beta
Nitroglycerin. Nitroglycerin tablets, sprays and patches can control chest pain by
opening up your coronary arteries and reducing your heart's demand for blood.
blockers (ARBs). These similar drugs decrease blood pressure and may help prevent
progression of coronary artery disease. If you've had a heart attack, ACE inhibitors
coronary arteries and cause the vessels to open, increasing blood flow to your heart.
this procedure, your doctor inserts a long, thin tube (catheter) into the narrowed part
of your artery. A wire with a deflated balloon is passed through the catheter to the
narrowed area. The balloon is then inflated, compressing the deposits against your
artery walls. A stent is often left in the artery to help keep the artery open. Some
coronary arteries using a vessel from another part of your body. This allows blood to
flow around the blocked or narrowed coronary artery. Because this requires open-
heart surgery, it's most often reserved for cases of multiple narrowed coronary
arteries
Complications
Chest pain (angina). When your coronary arteries narrow, your heart may not receive
enough blood when demand is greatest — particularly during physical activity. This can
Heart attack. If a cholesterol plaque ruptures and a blood clot forms, complete blockage of
your heart artery may trigger a heart attack. The lack of blood flow to your heart may
damage to your heart muscle. The amount of damage depends in part on how quickly you
receive treatment.
Heart failure. If some areas of your heart are chronically deprived of oxygen and nutrients
because of reduced blood flow, or if your heart has been damaged by a heart attack, your
heart may become too weak to pump enough blood to meet your body's needs. This
Abnormal heart rhythm (arrhythmia). Inadequate blood supply to the heart or damage
to heart tissue can interfere with your heart's electrical impulses, causing abnormal heart
rhythms.
Prevention
The same lifestyle habits that can help treat coronary artery disease can also help prevent it from
developing in the first place. Leading a healthy lifestyle can help keep your arteries strong and clear of
Quit smoking
Control conditions such as high blood pressure, high cholesterol and diabetes
Eat a low-fat, low-salt diet that's rich in fruits, vegetables and whole grains
People with impaired glucose tolerance have a higher risk for CHD. Even in the presence of
normoglycemia, an increase in cardiovascular risk is observed as the glucose increases. It has been
proposed that glucose is a continuous cardiovascular risk factor, similar to hypercholesterolemia and
hypertension.
In the Whitehall Study, there was an increase of 1.5- to 2-fold in CHD mortality for people
with a 2-hour post-50-g glucose load of 5.4 mmol/L (~95th percentile), independent of age, smoking,
The Rancho Bernado Study of 3,458 men and women followed for an average of 14 years
showed a linear increase in ischemic heart disease mortality rates with increasing fasting blood glucose
(FBG) in men. The threshold effect of increased mortality with FBG in women was an FBG of >110
mg/dl.Based on the above, dysglycemia has been proposed as a cardiovascular risk factor. Gerstein
postulated that plasma glucose concentrations are associated with different risk at different
concentrations:
in the diabetic range, glucose is associated with an increasing risk of macroangiopathies and
microangiopathies.
in the impaired glucose tolerance range, glucose is associated with an increased risk for diabetes
and CVD.
in the yet-to-be-defined "dysglycemia" glucose levels in the nor mal range, glucose is associated
Recently, FBG was called an underestimated risk factor for cardiovascular death. An FBG >85 mg/dl had
a relative risk of cardiovascular death for men of 1.4 even after adjusting for age, smoking habits, serum
lipids, blood pressure, and physical fitness. A meta-regression analysis of published data from 20 studies
of 95,783 individuals followed for 12.4 years showed the progressive relationship between glucose levels
Conclusion
The DM-CHD connection is complex. Hyperglycemia in the diabetic range does not explain all
of it. The prevalence and incidence of CHD are increased in people with diabetes. Many, but not all,
studies show an increased risk for CHD with rising fasting and post-challenge plasma glucose, even in the
It appears that diabetes, with hyperglycemia as its hallmark, is a major risk factor for
development of CHD and the adverse outcomes after MI. Intensive insulin therapy following MI in
Although adults with diabetes have a higher prevalence of cardiovascular risk factors, these
account for <50% of the excess mortality associated with diabetes. Clustering of cardiovascular risk
Although much new knowledge has been uncovered on the DM-CHD connection in the past
decade, more research to elucidate it is urgently needed. This is important, for it can affect significantly
28;111(25):3481-8.
2. Dorner M, Pinget M, Brogard JM (May 1977). "Essential labile diabetes". MMW Munch Med
3. Mills NL, Donaldson K, Hadoke PW, et al; Adverse cardiovascular effects of air pollution. Nat Clin
4. Derdemezis CS, Filippatos TD, Mikhailidis DP, et al; Review article: effects of plant sterols and
stanols beyond low-density J Cardiovasc Pharmacol Ther. 2010 Jun;15(2):120-34. Epub 2010 Mar
3.
5. Lawrence JM, Contreras R, Chen W, Sacks DA (May 2008). "Trends in the prevalence of
preexisting diabetes and gestational diabetes mellitus among a racially/ethnically diverse population
6. Nathan DM, Cleary PA, Backlund JY, Genuth SM, Lachin JM, Orchard TJ, Raskin P, Zinman B;
7. British National Formulary; 59th Edition (March 2010) British Medical Association and Royal
8. Nettleton JA, Steffen LM, Mayer-Davis EJ, et al; Dietary patterns are associated with biochemical
9. University Group Diabetes Program: A study of the effects of hypoglycemic agents on vascular
glycemia as a risk factor for ischemic heart disease death. Am J Epidemiol 133:565-76, 1991.
11. Bjornholt JV, Erikssen G, Aaser E, Sandvik L, Nitter-Hauge S, Jervell J, Erikssen J, Thaulow E:
Fasting blood glucose: an underestimated risk factor for cardiovascular death.Diabetes Care 22:45-
49, 1999.
12. Coutinho M, Gerstein HC, Wang Y, Yusuf S: The relationship between glucose and incident
13. UK Prospective Diabetes Study (UKPDS) Group: Intensive blood-glucose control with
14. Vrablik M, Prusikova M, Snejdrlova M, et al; Omega-3 fatty acids and cardiovascular disease risk: