Abstract
Atherosclerosis accompanies diabetes so commonly that it is almost not considered when discussing the complications of diabetes mellitus. While approximately one-third of the general North American population will die of atherosclerosis, this or a related disorder will underlie the death of three-quarters of the diabetics in North America.1 This picture is very different from that which was seen before the discovery of insulin, when only about one-fifth of diabetic deaths were due to vascular disease.2 This change has often been attributed to the discovery of insulin and the consequent increase in the survival of diabetics. The problem with such a facile explanation is that approximately 80% of diabetics are type 2 (NIDDM) diabetics, most of whom would not have died of ketoacidosis even before the discovery of insulin and most of whom do not depend on insulin for their survival. Hence, if the change in mortality pattern were to be explained by prolonged survival due to the discovery of insulin, one would expect that almost all of the cardiovascular disease in diabetics should be found in type 1 (IDDM) and/or in insulin-treated type 2 diabetics. This is probably not the case. Therefore one must look to other explanations, such as changing diagnostic criteria, changing general disease patterns, changing treatment methods in general, etc.
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References
G. Steiner, Diabetes and atherosclerosis: An overview, Diabetes, 30 (suppl. 2): 1–7, (1981).
S. Warren, P.M. LeCompte, and M.A. Legg, “The Pathology of Diabetes Mellitus,” Lea and Febiger, Philadelphia, p. 186, 4th ed. (1966).
T. Gordon, W.P. Castelli, M.C. Hjortland et al., Diabetes, blood lipids, and the role of obesity in coronary heart disease risk for women, Ann. Int. Med. 87: 393–403, (1977).
A.G. Shaper, K.T. Lee, R.F. Scott et al., Chemico-Anatomic studies in the geographic pathology of arteriosclerosis, Comparison of adipose tissue fatty acids in diabetics from East Africa and the United States with different frequencies of myocardial infarction, Am. J. Cardiol. 10: 390–399, (1962).
Y. Hirata, and T. Mihara, Principal causes of death among Japanese from 1968 to 1970, in: “Diabetes Mellitus in Asia,” S. Baba, Y. Goto, and I. Fukui, eds., Excerpta Medica, Amsterdam, p 91–97 (1976).
M. Alex, E.K. Goldenberg, and H.T. Blumenthal, An autopsy study of cerebrovascular accidents in diabetes mellitus, Circ. 25: 663–673 (1962).
H.U. Janka, E. Standl, and H. Mehnert, Peripheral vascular disease in diabetes mellitus and its relation to cardiovascular risk factors: Screening with the Doppler ultrasonic technique, Diabetes Care 3: 207–213 (1980).
K.W. Beach, J.D. Brunzell, and D.E. Strandness, Jr., Severe arteriosclerosis obliterans in patients with diabetes mellitus, Relation to smoking and form of therapy, Arteriosclerosis 2: 275–280 (1982).
R.I. Most, and P. Sinnock, The epidemiology of lower extremity amputations in diabetic individuals, Diabetes Care 6: 87–91 (1983).
L.J. Melton, P.J. Palumbo, M.S. Dwyer, and C.P. Chu, Impact of recent changes in diagnostic criteria on the apparent natural history of diabetes mellitus, Am. J. Epidemiol. 117: 559–565 (1983).
F.V. Crall, and W.C. Roberts, The extramural and intramural coronary arteries in juvenile diabetes mellitus, Analysis of nine necropsy patients aged 19–38 years with onset of diabetes before age 15 years, Am. J. Med. 64: 221–230 (1978).
I.I. Kessler, Mortality experience of diabetic patients, A 26 year follow-up study, Am. J. Med. 51: 715–724 (1971).
G. Goodkin, Mortality factors in diabetes, J. Occupational Med. 17: 716–721 (1975).
N.B. Ruderman, and C. Haudenshild, Diabetes as an atherogenic factor, Prog. in Cardiovasc. Dis. 26:373–412 (1984).
H.L. Grunnet, Cerebrovascular disease: diabetes and cerebral atherosclerosis, Neurol. 13: 486–491 (1963).
H.C. McGill, Diabetes and its vascular lesions in Diabetes and Atherosclerosis Connection, J. Moskowitz, ed., The Juvenile Diabetes Foundation, New York,:45–52 (1981).
R.J. Jarrett, H. Keen, and R. Chakrabarti, Diabetes, hyperglycemia and arterial disease in Complications of Diabetes, 2nd Ed. H. Keen and R.S. Jarrett eds., Edward Arnold Publishers Ltd., London,:179–204 (1982).
B.F. Waller, P.J. Palumbo, J.T. Lie, and W.C. Roberts, Status of coronary arteries of necropsy in diabetes mellitus with onset after age 30 years, Am. J. Med. 69: 498–507 (1980).
D.E. Strandness, R.E. Priest, and G.E. Gibbons, Combined clinical and pathologic study of diabetic and non-diabetic peripheral arterial disease, Diabetes 13: 366–372 (1964).
V.W. Fischer, H.B. Barner, and H.L. Leskin, Capillary basal laminar thickness in diabetic human myocardium, Diabetes 28: 713–719 (1979).
S.H. Factor, E.M. Okun, and T. Minase, Capillary microaneurysms in the human diabetic heart, N. Eng. J. Med. 302: 384–388 (1980).
M.D. Silver, V.F. Huckell, and M. Lorber, Basement membranes of small cardiac vessels in patients with diabetes and myxedema; preliminary observations, Pathology 9: 213–220 (1977).
H. Keen, and R.J. Jarrett, The WHO multinational study of vascular disease in diabetes: 2 Macrovascular disease prevalence, Diabetes Care 2: 187–195 (1979).
R.J. Jarrett, and H. Keen, The WHO multinational study of vascular disease in diabetes: 3 Microvascular disease, Diabetes Care 2: 196–201 (1979).
J.A. Colwell, M. Lopes-Virella, and P.V. Halushka. Patho- genesis of atherosclerosis in diabetes mellitus, Diabetes Care 4: 121–133 (1981).
G.H. Reaven, and G. Steiner, Proceedings of a conference on diabetes and atherosclerosis, Diabetes 30 (2): 1–110 (1981).
J.H. Fuller, P. McCartney, R.J. Jarrett, H. Keen, G. Rose, H.J. Shipley, and P.J.S. Hamilton, Hyperglycemia and coronary heart disease: The Whitehall study, J. Chronic Dis. 32: 721–728 (1979).
R. Stamler, J. Stamler, H.A. Lindberg, J. Marquardt, D.M. Berkson, O. Paul, M. Lepper, A. Dyer, and E. Stevens, Asymptomatic hyperglycemia and coronary heart disease in middle aged men in two employed populations in Chicago, J. Chronic. Dis. 32: 805–815 (1979).
R. Stamler, J. Stamler, J.A. Schoenberger, R.B. Shekelle, P. Collette, S. Shekelle, A. Dyer, D. Garside, and J. Wannamaker, Relationship of glucose tolerance to prevalence of ECG abnormalities and to 5-year mortality from cardiovascular disease: Findings of the Chicago Heart Association detection project in industry, J. Chronic Dis. 32: 817–828 (1979).
R. Stamler, and 3. Stamler, eds., Asymptomatic hyperglycemia and coronary heart disease, A series of papers by the International Collaborative Group, based on studies in fifteen populations, J. Chronic Dis. 32:683–837 (1979).
K.H. Gabbay, Hyperglycemia, polyol metabolism and complications of diabetes mellitus, Ann. Revs. Med. 26: 521–536 (1975).
R.P. Boot-Hanford, and H. Heath, The absence of sorbitol pathway activity in primary cultures of human umbilical vein endothelial cells, IRCS Med. Sci. Biochem. 9: 451 (abs) (1978).
R.W. Stout, Glucose inhibits replication of cultured human endothelial cells, Diabetologia 23: 436–439 (1982).
Y.A. Kesaniemi, J.L. Witztum, and U.P. Steinbrecher, Receptor-mediated catabolism of low sensity lipoprotein in man, J. Clin. Invest. 71: 950–959 (1983).
J.L. Witztum, U.P. Steinbrecher, M. Fisher, and A. Kesaniemi, Non-enzymatic glucosylation of homologous low density lipoprotein and albumin renders them immunogenic in guinea pigs, Pro. Nat. Acad. Sci. (U.S.A.) 80: 2757–2761, (1983).
H.F. Lopes-Virella, G.K. Sherer, A.H. Lees, H. Woltmann, R. Mayfield, J. Sagel, E.C. LeRoy, and J.A. Colwell, Surface binding, internalization and degradation by cultured human fibroblasts of low density lipoproteins isolated from type 1 (insulin-dependent) diabetic patients:changes with metabolic control, Diabetologia 22: 430–436 (1982).
A.R. Bassiony, H. Rosenberg, and T.L. McDonald, Glucosylated collagen is antigenic, Diabetes 32: 1182–1184 (1983).
H. Rosenberg, J.B. Modrak, J.H. Hassing, W.A. Al-Turk, and S. Stohs, Glucosylated collagen, Biochem. Byophys. Res. Comm. 91: 498–501, (1982).
B.W. Vogt, E.D. Schleicher, and O.H. Wieland, E Aminolysine bound glucose in human tissue obtained at autopsy, Diabetes 31: 1123–1129 (1982).
N. Peters, and C.N. Hales, Plasma insulin concentrations after myocardial infarction, Lancet 1: 1144–1145 (1965).
E.A. Nikkila, T.A. Miettinen, M.R. Vessenne, and R. Pelkonen, Plasma insulin in cononary heart disease, Lancet 2: 508–511 (1965).
F. Sorge, W. Schwartzkopff, and G.A. Neuhaus, Insulin response to oral glucose in patients with a previous myocardial infarction and in patients with peripheral vascular disease, Diabetes 25: 586–594 (1976).
M.H. Gertler, H.E. Leetma, E. Saluste, D.A. Covalt, and J.L. Rosenberg, Covert diabetes mellitus, ischemic heart disease and cerebrovascular disease, Geriatrics 27: 105–120 (1972).
T.A. Welborn, and K. Wearnw, Coronary heart disease incidence and cardiovascular mortality in Busselton with reference to glucose and insulin concentrations, Diabetes Care 2: 154–160 (1979).
K. Pyorala, Relationship of glucose tolerance and plasma insulin to the incidence of coronary heart disease: results from two population studies in Finland, Diabetes Care 2: 131–141 (1979).
P. Ducimitiere, L. Eschwege, P.L. Papoz, R.J.R. Claude, and G. Rosselin, Relationship of plasma insulin levels to the incidence of myocardial infarction and coronary heart disease mortality in a middle-aged population, Diabetologia 19: 205–210 (1980).
M. Vranic, S. Morita, and G. Steiner, Insulin resistance in obesity as analyzed by the response of glucose kinetics to glucagon infusion, Diabetes 29: 169–176 (1980).
G.H. Reaven, and J.H. Olefsky, Role of insulin resistance in the pathogenesis of hyperglycemia, in: “Diabetes, Obesity and Vascular Disease,” H.H. Katz and R.J. Mahler eds., John Wiley and Sons, New York,:229–266 (1978).
G. Steiner, S. Morita, and M. Vranic, Resistance to insulin but not to glucagon in lean human hypertriglyceridemics, Diabetes 29: 899–905 (1980).
G. Steiner, and M. Vranic, Insulin and hypertriglyceridemia: A vicious cycle with atherogenic potential, Int. J. Obesity 6 (suppl. 1): 117–124 (1982).
A.B. Cruz, D.S. Amatuzio, F. Grande, and L.J. Hay, Effect of intraarterial insulin on tissue cholesterol and fatty acids in alloxan-diabetic dogs, Circ. Res. 9: 39–43 (1961).
R.W. Stout, Development of vascular lesions in insulin treated animals fed a normal diet, Brit. Med. J. 3: 685–687 (1970).
A.V. Chobanian, G.C. Gerritsen, P.I. Brecher and L. McCombs, Aortic glucose metabolism in the diabetic Chinese hamster, Diabetologia 10: 589–593 (1974).
H. Wallinsky, S. Goldfischer, L. Capron, F. Capron, S.B. Coltoff-Schiller, and L. Kasak, Hydrolase activities in the rat aorta, I Effects of diabetes mellitus and insulin treatment, Circ. Res. 42: 821–831 (1978).
L. Capron, M. Phillipe, J.L. Guilmot, J.N. Feissinger, and E. Housset, Effect of insulin exposure upon the metabolism of rat aortic media: Influence of hydrostatic forces, Arterio- sclerosis 1: 345–352 (1981).
R.W. Stout, Relative insensitivity to glucagon of sterol synthesis in cultured rat aortic smooth muscle cells, Atherosclerosis 27: 271–278 (1977).
B. Pfeifle and H. Ditschuneit, Effect of insulin on the growth of smooth muscle cells in vitro, Diabetologia 20: 155–158 (1981).
R.W. Stout, E.L. Bierman, and R. Ross, Effect of insulin on the proliferation of cultured primate arterial smooth muscle cells, Circ. Res. 36: 319–327 (1975).
H. Taggart, and R.W. Stout, Control of DNA synthesis in cultured vascular endothelial and smooth muscle cells, Atherosclerosis 37: 549–557 (1980).
G.L. King, S.M. Buzney, R.C. Kahn, N. Hetu, S. Buchwald, S.G. MacDonald, and R.I. Rand, Differential responsiveness to insulin of endothelial and support cells from microand macrovessels, J. Clin. Invest. 71: 974–979 (1983).
J.H. Miller, and M.D. Bogdanoff, Antidiuresis associated with administration of insulin, J. Appl. Physiol. 6: 509–512 (1954).
R.A. DeFronzo, C.R. Cooke, R. Andres, G.R. Faloona, and P.J. Davis, The effect of insulin on renal handling of sodium, potassium, calcium and phosphate in man. J. Clin. Invest. 55: 845–855 (1975).
G. Steiner, F. Haynes, G. Yoshino, and M. Vranic, Hyperinsulinemia and in vivo very-low-density lipoprotein tri-glyceride kinetics, Am. J. Physiol. 246: E187–E192 (1984).
D.A. Streja, E.B. Marliss, and G. Steiner, The effects of prolonged fasting on plasma triglyceride kinetics in man, Metabolism 26: 505–516 (1977).
D.C. Cattran, G. Steiner, D.R. Wilson, and S.S.A. Fenton, Hyperlipidemia after renal transplantation: natural history and pathophysiology, Ann. Int. Med. 91: 554–559 (1979).
C.N. Sadur, and R.H. Eckel, Insulin stimulation of adipose tissue lipoprotein lipase, Use of the euglycemic clamp technique, J. Clin. Invest. 69: 1119–1125 (1982).
E.A. Nikkila, High density lipoproteins in diabetes, Diabetes 30 (suppl. 2): 82–87 (1981).
A. Chait, E.L. Bierman, and J.J. Albers, Low density lipoprotein receptor activity in cultured human skin fibroblasts, Mechanism of insulin-induced stimulation, J. Clin. Invest. 64: 1309–1319 (1979).
K. Asplund, E. Hagg, C. Helmers, F. Lithner, T. Strand, and P. Wester, The natural history of stroke in diabetic patients, Acta Med. Scand. 207: 417–424 (1980).
C.J. Pepine, and W.W. Nichols, Aortic input impedance in cardiovascular disease, Prog. Cardiovac. Dis. 24: 307–318 (1982).
S. Glagov, Hemodynamic risk factors: Mechanical stress mural architecture, medial nutrition and vulnerability of arteries to atherosclerosis, in: “The Pathogenesis of Atherosclerosis,” R.W. Wissler and C.J. Geer eds., Williams and Wilkins, Baltimore,:164–199 (1972).
H.P. Dustan, Mechanism of hypertension associated with obesity, Ann. Int. Med. 98: 860–864, (1983).
H.Keen, N.S. Track, and G.S.C. Sowry, Arterial pressure in clinically apparent diabetics, Diabete et Metabolisme 1: 159–178 (1975).
T.R. Dawber, “Diabetes and cardiovascular disease in The Framingham Study,” Harvard University Press, Cambridge: 190–201 (1980).
E. Barrett-Connor, H.H. Criqui, H.R. Klauber, and M. Holdbrook, Diabetes and hypertension in a community of older adults, Am. J. Epidemiol. 113: 276–284 (1981).
R.J. Jarrett, H. Keen, M. McCartney, J.H. Fuller, P.J.S. Hamilton, D.D. Ried, and G. Rose, Glucose tolerance and blood pressure in two population samples: their relation to diabetes mellitus and hypertension, Int. J. Epidemiol. 7: 15–24 (1978).
S. Pell, and C.A. D’Alonzo, Some aspects of hypertension in diabetes mellitus, Am. Med. Assoc. J. 202: 104–110 (1967).
P.L. Drury, Diabetes and arterial hypertension, Diabetologia 24: 1–9 (1983).
G. Steiner, M.A. Poapst, and J.K. Davidson, Production of chylomicron-like lipoproteins from endogenous lipid by intestine and liver of diabetic dogs, Diabetes 24: 263–271 (1975).
J.D. Brunzell, Mechanisms of hyperlipidemia in diabetes mellitus in Diabetes and Atherosclerosis Connection, J. Moskowitz ed., Juvenile Diabetes Foundation, New York, (1981), p 181–192.
B.R. Zimmerman, P.J. Palumbo, W.A. O’Fallon, R.D. Ellofson, P.J. Osmundson, and F.J. Kazmier, A prospective study of peripheral occlusive arterial disease in diabetes, III. Initial lipid and lipoprotein findings, Mayo Clin. Proc. 56: 223–242 (1981).
M.F. Reardon, N.H. Fidge, and P.J. Nestel, Catabolism of very low density lipoprotein B apoprotein in man, J. Clin. Invest. 61: 850–860 (1978).
H.F. Reardon and G. Steiner. The use of kinetics in investigating the metabolism of very low and intermediate density lipoproteins, in: “Lipoprotein Kinetics and Modeling,” M. Berman, S.M. Grundy and B. Howard eds., Acad. Press, New York (1982).
G. Schonfeld, C. Birge, J.P. Miller, G. Kessler, and J. Santiago, Apolipoprotein B levels and altered lipoprotein composition of diabetes, Diabetes 23: 827–834 (1974).
M. Mancini, A. Rivellese, P. Rubba, and G. Riccardi, Plasma lipoproteins in maturity onset diabetes, Nutr. Metab. 24 (suppl 1): 65–73 (1980).
M.R. Taskinen, E.A. Nikkila, T. Kuusi, and K. Harno, Lipoprotein lipase in untreated type 2 (insulinindependent) diabetes associated with obesity, Diabetologia 22: 44–50 (1982).
W. Beach, J.D. Brunzell, L.L. Conquest, and D.E. Strandness, The correlation of arteriosclerosis obliterans with lipoproteins in insulin-dependent and non-insulin-dependent diabetes, Diabetes 28: 836–840 (1979).
E.R. Briones, S.J.T. Mao, P.J. Palumbo, W.H. O’Fallon, W. Chenoweth, and B.A. Kottke, Analysis of plasma lipids and apolipoproteins in insulin-dependent and non-insulin-dependent diabetics, Metabolism 33: 42–49 (1984).
H. Bar-On, P.S. Roheim, and H. Eder, Serum lipoproteins and apolipoproteins in rats with streptozotocin-induced diabetes, J. Clin. Invest. 57: 714–721 (1976).
R.H. Eckel, J.J. Albers, H.C. Chung, P.W. Wahl, F.T. Lindgren, and E.L. Bierman, High density lipoprotein composition in insulin-dependent diabetes mellitus, Diabetes 30: 132–138 (1981).
P.N. Durrington, R.S. Newton, D.B. Weinstein, and D. Steinberg, Effects of insulin and glucose on very low density lipoprotein triglyceride secretion by cultured rat hepatocytes, J. Clin. Invest. 70: 63–73 (1982).
W. Patsch, S. Franz, and G. Schonfeld, Role of insulin in lipoprotein secretion by cultured rat hepatocytes, J. Clin. Invest. 71: 1161–1174 (1983).
T. Kazumi, M. Vranic, and G. Steiner, Comparison of portal vs peripheral hyperinsulinemia on VLDL-triglyceride kinetics, Proc. 7th Int. Endoc. Conk. (abst ) (1984).
D.B. Zilversmit, Atherogenesis, a post–prandial phenomenon, Circulation 60–473–485 (1979).
H.B. Jones, J.W. Gofman, F.T. Lindgr, T.P. Lyon, D.H. Graham, B. Strisower, and A.V. Nichols, Lipoproteins in atherosclerosis, Am. J. Med. 11: 358–380 (1951).
S. Moore, R.J. Friedman, D.P. Singal, J. Gauldie, H.A. Blajchman, and R.S. Roberts, Inhibition of injury induced thromboatheroscierotic lesions by anti-platelet serum in rabbits, Thromb. Haemostasis 35: 70–81 (1976).
R. Ross, and J.A. Glomset, The pathogenesis of atherosclerosis, N. Eng. J. Med. 295:369–377 and 420–425 (1976).
J.F. Mustard, and H.A. Packham, Platelets and diabetes mellitus, N. Eng. J. Med. 297: 1345–1347 (1977).
J.A. Colwell, P.D. Winocour, H. Lopes-Virella, and, P.V. Halushka, New concepts about the pathogenesis of atherosclerosis in diabetes mellitus, Am. J. Med. 67–80 (1983).
E. Standl, and H. Mehnert eds., Pathogenetic concepts of diabetic microangiopathy, Hormone Metb. Res. 11(suppl.):1–58 (1981).
H. Keen, B.J. Thomas, and R.J. Jarrett, Obesity and cardiovascular risk, Int. J. Obesity 6 (suppl. 1): 83–89 (1982).
R.J. Jarrett, Type 2 (non-insulin-dependent) diabetes mellitus and coronary heart disease-chicken, egg or neither? Diabetologia 26: 99–102 (1984).
T. Mandrup-Poulsen, P. Owerbach, S.A. Mortensen, K. Johansen, H. Meinertz, H. Sorensen, and J. Nerup, DNA sequences flanking the insulin gene on chromosome 11 confer risk of atherosclerosis, Lancet 1: 250–252 (1984).
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Steiner, G. (1985). Atherosclerosis, the Major Complication of Diabetes. In: Vranic, M., Hollenberg, C.H., Steiner, G. (eds) Comparison of Type I and Type II Diabetes. Advances in Experimental Medicine and Biology, vol 189. Springer, Boston, MA. https://doi.org/10.1007/978-1-4757-1850-8_15
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