**Cardiovascular Disease and Diabetes: Two Sides of the Same Coin!**

Sayeeda Rahman, Md. Anwarul Azim Majumder, Russell Kabir, Mainul Haque, Subir Gupta, Sana Mohammad Yasir Arafat, Nkemcho Ojeh and Prasad Dalvi

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.69038

#### **Abstract**

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Cardiovascular disease (CVD) and type 2 diabetes (T2DM) are rapidly rising around the globe. Empirical researches demonstrated rapid increase in mortality and morbidity related to CVD and T2DM. Much of the diabetes-associated morbidity and mortality predominantly reflects its deleterious effect on macrovascular and microvascular diseases. The microvascular complications of T2DM include retinopathy, neuropathy and nephropathy and the macrovascular complications include ischemic heart disease, cerebrovascular disease and peripheral vascular diseases. Research indicates that coronary heart disease (CHD) is the major cause of mortality in people with T2DM. Herein, this chapter reviews relationship between CVD and T2DM, associated complications and effectiveness of relevant treatment modalities to treat/prevent diabetic macrovasculopthy. Macrovascular disease occur due to underlying obstructive atherosclerotic changes of major arteries which cause functional and structural abnormalities of blood vessels. The long-term complications can be controlled and prevented by controlling glycemia, maintaining normal lipid profiles, adopting a healthy lifestyle and using pharmacological interventions. Clinical trials have shown that lifestyle interventions help in prevention and reduction of CVD risk, but evidence for long-term CVD outcomes is lacking. A multidisciplinary approach involving patients, health professionals and researchers and governments should be undertaken to reduce the incidence and prevalence of diabetesrelated cardiovascular complications.

**Keywords:** cardiovascular diseases, type 2 diabetes, vasculopathy, macrovascular diseases, atherosclerosis, pathophysiology, pathogenesis

© 2017 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

### **1. Introduction**

Cardiovascular disease (CVD) is the major cause of morbidity and mortality in people with type 2 diabetes (T2DM) [1, 2], and coronary heart disease (CHD) is the most common cause of death among people with T2DM. It is estimated that up to 80% of the 200 million people suffering with T2DM globally die of CVD every year [3, 4]. In recent years, the pandemic of T2DM has emerged as a major and growing health problem. The cardiovascular (CV) complications associated with T2DM cause a considerable amount of disability, premature mortality, loss of productivity and tremendously increase burden on health care systems and economies worldwide [5–7]. Among the major complications, the development of CVD is two to four times higher in people with T2DM as compared with people without the condition [8, 9]. Thus, CVD and T2DM have become inseparable which need to be addressed by the global health initiatives.

T2DM acts as an independent risk factor for several forms of CVD (micro- and macrovascular diseases), and people with T2DM are more likely to develop CVD due to a variety of risk factors [10]. Preclinical manifestations of macrovascular diseases are developed much earlier in newly diagnosed, never-treated T2DM patients [11], and such macrovascular changes are also observed even in normoglycemic and normotensive offspring of parents with T2DM [12, 13]. Furthermore, early manifestations of preclinical vasculopathy and development of macrovascular disease were potentially found to be at increased risk with impaired glucose tolerance (IGT) [13]. The CV complications of T2DM have a significant impact on individuals, families, health systems, and economic development worldwide [14]. According to the International Federation of Diabetes, \$673 billion was spent on diabetes in 2015 which is 12% of global health expenditure [15]. It is imperative to control the initiators of vasculopathy that ultimately develop into long-term CV complications by adopting a healthy lifestyle and using pharmacological interventions. This chapter reviews relationship between CVD and T2DM, associated complications and relevant treatment modalities to treat/prevent diabetic macrovasculopthy.

### **2. Cardiovascular disease risk in diabetes**

CVD are the number one cause of death globally – more people die annually from CVD than from any other cause. Individuals at risk of CVD may demonstrate hypertension, hyperglycemia, and hyperlipidemia as well as overweight and obesity. According to World Health Organization [16]:


The main contributing factor in the increasing prevalence of CVD deaths is the increase in the cases of diabetes at very alarming rate, in particular, due to increasing prevalence of obesity, lifestyle choices, urbanization, aging, and genetic factors [17]. According to the International Diabetic Federation [15]:


**1. Introduction**

72 Recent Trends in Cardiovascular Risks

Cardiovascular disease (CVD) is the major cause of morbidity and mortality in people with type 2 diabetes (T2DM) [1, 2], and coronary heart disease (CHD) is the most common cause of death among people with T2DM. It is estimated that up to 80% of the 200 million people suffering with T2DM globally die of CVD every year [3, 4]. In recent years, the pandemic of T2DM has emerged as a major and growing health problem. The cardiovascular (CV) complications associated with T2DM cause a considerable amount of disability, premature mortality, loss of productivity and tremendously increase burden on health care systems and economies worldwide [5–7]. Among the major complications, the development of CVD is two to four times higher in people with T2DM as compared with people without the condition [8, 9]. Thus, CVD and T2DM have become inseparable which need to be addressed by the global health initiatives.

T2DM acts as an independent risk factor for several forms of CVD (micro- and macrovascular diseases), and people with T2DM are more likely to develop CVD due to a variety of risk factors [10]. Preclinical manifestations of macrovascular diseases are developed much earlier in newly diagnosed, never-treated T2DM patients [11], and such macrovascular changes are also observed even in normoglycemic and normotensive offspring of parents with T2DM [12, 13]. Furthermore, early manifestations of preclinical vasculopathy and development of macrovascular disease were potentially found to be at increased risk with impaired glucose tolerance (IGT) [13]. The CV complications of T2DM have a significant impact on individuals, families, health systems, and economic development worldwide [14]. According to the International Federation of Diabetes, \$673 billion was spent on diabetes in 2015 which is 12% of global health expenditure [15]. It is imperative to control the initiators of vasculopathy that ultimately develop into long-term CV complications by adopting a healthy lifestyle and using pharmacological interventions. This chapter reviews relationship between CVD and T2DM, associated complications and relevant treatment modalities to treat/prevent diabetic macrovasculopthy.

CVD are the number one cause of death globally – more people die annually from CVD than from any other cause. Individuals at risk of CVD may demonstrate hypertension, hyperglycemia, and hyperlipidemia as well as overweight and obesity. According to World Health

• Approximately 17.5 million people died worldwide from CVDs in 2012, representing 31%

• Of all CVD deaths, an estimated 7.4 million were due to CHD and 6.7 million were due to

• Of the 16 million deaths (≤70 years of age) as a result of non-communicable diseases 37%

• An estimated 75% of CVD deaths take place in low- and middle-income countries.

**2. Cardiovascular disease risk in diabetes**

Organization [16]:

of all deaths.

are caused by CVDs.

stroke.

• Five million deaths occurred in 2015 as a result of diabetes.
