Cardiovascular disease and type 2 diabetes mellitus: A multifaceted symbiosis

Abstract

Chronic hyperglycaemia (e.g. type 2 diabetes mellitus (T2DM) and prediabetes) in humans is associated with an increased risk of cardiovascular (CV) complications, and, vice versa, the presence of CV complications (e.g. myocardial infarction, stroke or intermittent claudication) among patients heightens the risk of T2DM or prediabetes. In both cases (i.e. chronic hyperglycaemia and CV complications), significant diagnostic and treatment challenges resulting from a broad range of factors may serve as barriers to reducing the deleterious societal impact of T2DM and prediabetes. These challenges often include clinicians: failing to intervene early and aggressively enough among patients with T2DM to achieve CV risk factor control; failing to efficaciously identify T2DM patients with already established CV complications; and failing proactively to assess individuals at high risk for T2DM. This review discusses the apparent symbiosis between CV disease and T2DM, with a focus on identifying patients with established T2DM or at risk for T2DM; traditional and novel risk factors and markers for CV disease in T2DM; challenges related to diagnosing CV disease in T2DM; and organization of T2DM care in order to prevent CV complications. These are issues that require attention because identifying patients at high risk for T2DM can halt or reduce their further glycaemic deterioration if addressed properly, and because novel markers and non‐invasive tests could be applied in patients with T2DM as a means of detecting and possibly treating unrecognized CV disease in time. Furthermore, several approaches for T2DM care can be effective in controlling the CV risk factors contributing to CV complications.

• Cardiovascular complications
• coronary angiography
• coronary artery disease
• inflammation
• prediabetes
• prevention
• type 2 diabetes mellitus

Acknowledgements

I am indebted to my supervisors, Professors Kåre I. Birkeland and Lars Gullestad, and to Ms. Elsa Orvik. I am also grateful to the management, staff and colleagues at Asker and Baerum Hospital, especially in the Medical Department (in particular Dr. Arnljot Tveit and Dr. Britt Eidsvoll), who have been extremely supportive in allowing me time and the facilities to conduct my research. I warmly thank participants in the studies and, not least, the Eastern Norway Health Authority and the Asker and Baerum Hospital for funding. Finally, without the encouragement of my wife, Belinda Abrahamsen, this thesis would never have seen the light of day.