الفهرس 
Cardiovascular risk factors in diabetes mellitusOnly 14 pages are availabe for public view
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Abstract
ype 2 Diabetes Mellitus (DM2) is an important public health problem worldwide because of its high prevalence and complications.
Currently, atherosclerosis is indicated as the main cause for CVD development. Once clinical cardiovascular disease develops, these patients have a poorer prognosis than normoglycemic patients. By inducing endothelial changes, hyperglycemia contributes directly to atherosclerosis.
Over the past years, it has been recognized that inflammation may contribute to all stages of the atherosclerotic process. Furthermore, a variety of other biomarkers have been proposed to add value beyond traditional risk factors in predicting future coronary events. Perhaps the most celebrated of these is C- reactive protein (CRP).
An elevated CRP level has been an independent predictor of diabetes. Recent cross-sectional studies have also demonstrated clear associations of elevated serum CRP levels with obesity and insulin resistance.
Elevated levels of CRP are observed in the elderly, in smokers, in those who exhibit glucose intolerance, and in the obese. In general, those with type 2 diabetes are noted to have higher CRP level, although not consistently.
Cigarette smoking doubles the risk of cardiovascular disease in patients with diabetes and attenuates whatever benefits occur from modifying other risk factors.
Glycemic control improves the characteristic dyslipidemia of diabetes, particularly elevated triglyceride levels.
Tight control of blood pressure has been shown to reduce cardiovascular morbidity and mortality in patients with diabetes.
Statins increase LDL receptor-mediated clearance of apoB lipoproteins, particularly LDL, when baseline LDL receptor activity is reduced. However, in patients with dyslipidemia associated with insulin resistance/T2DM, where secretion of VLDL and LDL into the circulation is prominent, statins can improve lipid levels by reducing the assembly and secretion of apoB lipoproteins with or without concomitant changes in fractional clearance, statins may reduce the assembly and secretion of apoB lipoproteins by inhibiting cholesterol synthesis.
Diabetes is the seventh leading cause of death, and heart disease is the leading cause of diabetes-related deaths, adults with diabetes have heart disease death rates about 2 to 4 times as high as that of adults without diabetes.
Patients with diabetes are characterized by an increased likelihood of heart failure, largely reflecting the contribution of diabetes to coronary artery disease and its association with hypertension.
Recently it has been demonstrated that the aorta is not a simple conduit for the distribution of blood, but rather has a fundamental role in the function of the cardiovascular system. Increased aortic stiffness and decreased distensibility, which indicate impairment in the elastic structure of the aorta, are associated with CAD and CAD risk factors.
Type 2 diabetes mellitus increases aortic stiffness even in the absence of hypertension and CAD. Furthermore, the impaired aortic elastic properties are related to the duration of diabetes and poor glycemic control.
The abdominal aorta (AA) has a predilection for aneurysm formation. One factor of importance may be that the aorta is the largest artery in the body, and wall stress is related to arterial diameter. Furthermore, the AA dilates 25% between the age of 25 and 70 years. Remodeling and degeneration of the wall is accompanied by altered composition of the vessel wall, with increasing collagen-elastin ratio.
Abdominal aorta in diabetic patients might be affected by a changed remodeling response, and thus changed arterial wall stress compared to healthy subjects.
So a case-control study was conducted to investigate the correlation between aortic diameter at the level of iliac bifurcation and echo findings in elderly diabetic patients for early detection of cardiovascular affection among them. 90 elderly patients recruited from Ain shams University hospitals all patients aged 60 or more, of both sexes, 30 females 30 males case group and 30 control group, Case group include diabetic patients only.
Any other uncontrolled co morbidity e.g, ischemic heart disease, uncontrolled hypertension, renal or hepatic diseases…etc were excluded.
All participants underwent:
1. Comprehensive geriatric assessment.
2. Trans-thoracic echocardiography: using 2.5-3.5 MH transducer. All measures will be taken via transapical or parasternal views except in poorly echogenic patients the values will be estimated from subcostal views. The following measures will be done:
a) Left ventricular dimensions (EDD and ESD) and wall thickness (posterior wall and IVS).
b) Left ventricular systolic function (%FS and EF) by M-mode.
c) Left atrial size.
d) Annular aortic root.
3. Abdominal ultrasound to assess aortic diameter at the level of iliac bifurcation, the maximum diameter of the aorta was measured from leading edge to leading edge.
4. Biochemical tests for detection of coronary risk factors including:
a. Total cholesterol, triglycerides, high density lipoprotein, low density lipoprotein.
b. Fasting blood sugar.
c. 2 hours post prandial sugar level.
d. Serum C-reactive protein.
By statistical analysis it was found that there is a high statistical significant difference between cases and control, as regard FBS, 2hpp, T.CHOL, CRP, insignificant negative correlation between CRP and aortic diameter, negative correlation was found between Aortic diameter and other cardiovascular risk factors including FBS, 2hpp, lipid profile which were insignificant in the case group, highly statistical significant difference between cases and control as regard IMT. Statistical significant difference between two groups as regard LVEDD, LVESD, EF, FS, LAD. Only significant negative correlation between EF and aortic diameter, with no other correlations which can be attributed to the smaller sample size and the patients were asymptomatic. Also in the current study there was statistical significant difference between males and females as regard aortic root diameter, TG, CRP, BMI and smoking.
Finally higher sensitivity, specificity and accuracy of the abdominal U/S to detect abdominal aortic diameter between case and control group than the sensitivity, specificity and the accuracy of the trans-thoracic echocardiography in measuring aortic root diameter between case and control group.
The results of the current study suggest that good control of diabetes is necessary to avoid cardiovascular atherosclerotic disease, include inflammatory markers as CRP, dyslipidemia and hyperglycemia.
Abdominal Ultrasound measuring aortic diameter at the level of iliac bifurcation is necessary in all asymptomatic diabetic patients for early detection of cardiovascular affection among them, related to its high sensitivity, specificity and accuracy