characters with diabetes are at hig...

characters with diabetes are at higher risk for cardiovascular disease because classical risk factors including obesity, dyslipidemia, and hypertension are usual in this group. However, the link between cardiovascular disease and hyperglycemia is not as clear. Studies have shown that improved glycemic repress decreases the risk of microvascular conditions (eg retinopathy, neuropathy, nephropathy), still its effect on coronary heart disease, rap peripheral arterial disease, and other macrovascular diseases has been equivocal. Selvin and associates performed a systematic review of published reports to explore the relationship between long-term glycemic superintend and the risk of cardiovascular disease in bodys with type 1 and shadow 2 diabetes.

Studies bearinged between 1966 and 2003 that reported A1C measures; included characters with diabetes; and examined for cardiovascular results such as peripheral arterial disease, coronary heart disease, and shock were included.

In their final analysis, the authors loched data from 17 reports to measure the relative risk (RR) estimate through percentage-point increase in A1C for each cardiovascular issue For persons with type 1 diabetes, the RR was 115 (95 percent confidence interval [CI], 092 to 143) for coronary heart disease and 132 (95 percent CI, 119 to 145) for peripheral arterial vascular disease. visitation data by level of A1C were not available for this group

For parts with type 2 diabetes, the RR was 118 (95 percent CI, 110 to 126) for total cardiovascular disease, 117 (95 percent CI, 109 to 125) for hit and 1.28 (95 percent CI, 118 to 139) for peripheral arterial vascular disease. These eventuates support the concept that hyperglycemia increases cardiovascular risk in living bodys with type 1 and exemplar 2 diabetes. The only inquiry included in this analysis that specifically evaluated the ability of glucose-lowering regimens to decrease cardiovascular morbidity or death was the United Kingdom Prospective Diabetes studious mood Although the study found that improved glycemic ascendency can moderately decrease cardiovascular risk (with the exception of stroke) it did not demonstrate statistical significance.

The authors decide that, according to the meta-analysis, hyperglycemia is associated with increased cardiovascular risk in bodys with types 1 and 2 diabetes. If this is accurate, improved glycemic command may lower cardiovascular risk in patients with diabetes. Cardiovascular disease is belonging to all among persons with diabetes because of factors other than hyperglycemia; therefore, further studies are requireed to confirm this finding. Also, the single study included in this analysis that specifically direct the eyeed at the ability of glucose-lowering regimens to decrease cardiovascular morbidity did not demonstrate statistically significant results

Selvin E et al. Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Ann Intern M September 21 2004;141:421-31

EDITOR'S NOTE: In an editorial (1) in the same issue, Gerstein notes that the be deriveds of the metaanalysis above demonstrate the significant association between elevated A1C of the same heights and the risk of coronary heart disease and peripheral vascular disease. A six-year cohort subject of attention (2) that evaluated the relationship between A1C measurement and cardiovascular conclusions in persons with and without diabetes set that A1C levels may be an independent predictor of cardiovascular complications. Gerstein infers that, based on the springs of these two reports, elevated A1C plains in persons with or without diabetes should be added to the list of commonly accepted cardiovascular risk factors, similar as hypertension and elevated cholesterol horizontals Further studies are needed to confirm whether lowering A1C on a levels has a positive impact forward cardiovascular event risk. In the meantime, the author encourages lifestyle changes that can help diminish diabetes and A1C levels.--R.S.

REFERENCES

(1) Gerstein HC Glycosylated hemoglobin: finally ready for prime time as a cardiovascular risk factor. Ann Intern M 2004;141:475-6

(2) Khaw K Wareham N Bingham s Luben R, Welch A, Day N Association of hemoglobin A1c with cardiovascular disease and mortality in adults: the European Prospective Investigation into Cancer in Norfolk. Ann Intern M 2004;141:413-20

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