Coronary Heart Disease and Diabetes Complications

Diabetes Complications: Microvascular vs. Macrovascular

  • Microvascular:
    • Retinopathy, neuropathy, nephropathy.
    • Strongly linked to glycemia levels; poorer control increases risk.
    • HbA1c cutoff of 6.5% as a diagnostic criterion is based on increased retinopathy risk above this level.
    • Prevalence: Retinopathy (30%), nephropathy/neuropathy (40-50%), nephropathy (60%).
  • Macrovascular (ASCVD):
    • Coronary heart disease, heart failure, peripheral arterial disease, stroke.
    • Can start before diabetes onset, even with obesity or insulin resistance.
    • Driven by multiple parameters, with obesity as a key factor (common soil hypothesis).

Common Soil Hypothesis

  • Obesity leads to insulin resistance.
  • This resistance contributes to coronary heart disease, heart failure, diabetes, and hypertension.
  • These conditions share a common underlying factor related to obesity and insulin resistance.