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Diabetes and Heart Disease

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Coronary Artery Disease

Part of the book series: Cardiovascular Medicine ((CVM))

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Abstract

Diabetes, insulin resistance, and heart disease are extraordinarily common. Furthermore, they are inextricably linked. The nature, cause-consequence connections, pathogenetic features, and diagnostic and therapeutic implications are the focus of this chapter. The seminal forms of heart disease, hypertensive heart disease, heart failure, and coronary artery disease, are those most ineluctably conflated with diabetes and insulin resistance. Numerous pathogenetic links are responsible. Though prevention and therapy of each are concordant with principles of management applicable to the same disorders in the general population, specific therapeutic considerations apply in patients with insulin resistance. Thus, knowledge of insulin resistance and diabetes is essential in informing treatment of heart disease. The panoply of therapeutics now available for treatment of diabetes provides powerful opportunities for amelioration of cardiovascular sequelae. Accordingly, the truly effective physician must function as both a diabetologist and a cardiologist to maximize the capacity to confer benefit to patients served. This chapter is designed to provide the information needed to facilitate achieving the necessary duality.

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Abbreviations

A1C:

Hemoglobin A1c

ACE:

Angiotensin-converting enzyme

ACS:

Acute coronary syndrome

AGE:

Advanced glycation end product

ARB:

Angiotensin II receptor blocker

CABG:

Coronary artery bypass grafting

CAD:

Coronary artery disease

CAN:

Cardiovascular autonomic neuropathy

CDE:

Certified diabetes educator

CPT-1:

Carnitine palmitoyltransferase-1

CRP:

C-reactive protein

CVD:

Cerebral vascular disease

DAG:

Diacylglycerol

FA:

Fatty acid(s)

FFA:

Free fatty acid(s)

GLUT4:

Glucose transporter 4

HDL:

High density lipoprotein

HGO:

Hepatic glucose output

IDL:

Intermediate density lipoprotein

IP:

Insulin-providing

IS:

Insulin-sensitizing

LADA:

Latent autoimmune diabetes in adults

LCAC:

Long-chain acylcarnitine

LDL:

Low density lipoprotein

LPL:

Lipoprotein lipase

MI:

Myocardial infarction

MODY:

Maturity onset diabetes of the young

PAD:

Peripheral arterial disease

PAI-1:

Plasminogen activator inhibitor-1

PCI:

Percutaneous coronary intervention

PKC:

Protein kinase C

RAAS:

Renin-angiotensin-aldosterone system

RAGE:

Receptor for advanced glycation end products

TZD:

Thiazolidinedione

UPA:

Urokinase-type plasminogen activator

VLDL:

Very low density lipoprotein

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Acknowledgment

The preparation of the typescript and illustrations by Becky Aksdal is most appreciated.

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Authors and Affiliations

  1. Department of Medicine, Cardiovascular Research Institute, University of Vermont College of Medicine, Colchester, VT, USA

    Burton E. Sobel MD

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  1. Burton E. Sobel MD
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  1. Cardiology Division, President, Texas Heart Institute, Houston, Texas, USA

    James T. Willerson

  2. Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota, USA

    David R. Holmes, Jr.

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Sobel, B.E. (2015). Diabetes and Heart Disease. In: Willerson, J., Holmes, Jr., D. (eds) Coronary Artery Disease. Cardiovascular Medicine. Springer, London. https://doi.org/10.1007/978-1-4471-2828-1_6

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