Diabetes coronary artery disease

Women with controlled dyslipidemias can use low-dose CHCs, with periodic monitoring of fasting lipid profiles. Women with uncontrolled dysiipidemia (LDL greater than 160 mg/dL, HDL less than 35 mg/dL, triglycerides greater than 250 mg/dL) and additional risk factors (e.g., coronary artery disease, diabetes, hypertension, smoking, or a positive family history) should use an alternative method of contraception. 

The diagnosis of depression still rests primarily on the clinical interview. Major depressive disorder (MDD) is characterized by depressed mood most of the time for at least 2 weeks and/or loss of interest or pleasure in most activities. In addition, depression is characterized by disturbances in sleep and appetite as well as deficits in cognition and energy. Thoughts of guilt, worthlessness, and suicide are common. Coronary artery disease, diabetes, and stroke appear to be more common in depressed patients, and depression may considerably worsen the prognosis for patients with a variety of comorbid medical conditions. 

Diabetes is highly prevalent in the heart failure population, with current estimates indicating that it is present in approximately one-third of heart failure patients. Diabetes may contribute directly to systolic or diastolic dysfunction, as well as indirectly by contributing to the development of coronary artery disease. Diabetes is an independent risk factor for developing heart failure, and its presence is associated with a hastened progression of heart failure and worse prognosis. 

Free radicals are not just esoteric reactants they are the agents of cell death and destruction. They are involved in all chronic disease states (e.g., coronary artery disease, diabetes mellitus, arthritis, and emphysema) as well as acute injury (e.g., radiation, strokes, myocardial infarction, and spinal cord injury). Through free radical defense mechanisms in our cells, we can often restrict the damage attributed to the "normal" aging process. 

Cancer, high blood pressure, coronary artery disease, diabetes and arthritis are among the lethal or chronic crippling diseases associated with older age. 

LRP6 Missense mutation (familial, autosomal dominant) Autosomal dominant early coronary artery disease (hyperlipidemia, hypertension, diabetes)... 

Mother is alive at age 87 with coronary artery disease father is deceased from diabetes she has no siblings. 

Prolonged exposure to elevated GH and IGP-Is can lead to serious complications in patients with acromegaly. Aggressively manage comorbid conditions such as hypertension, diabetes, arrhythmias, coronary artery disease and heart failure to prevent vascular and neuropathic complications. It is critical to monitor patients indefinitely for management of the comorbidities associated with acromegaly8 (Table 43-4). 

The risk of gout increases as the serum uric acid concentration increases, and approximately 30% of patients with levels greater than 10 mg/dL (greater than 595 pmol/L) develop symptoms of gout within 5 years. However, most patients with hyperuricemia are asymptomatic. Other risk factors for gout include obesity, ethanol use, and dyslipidemia. Gout is seen frequently in patients with type 2 diabetes mellitus and coronary artery disease, but a causal relationship has not been established. 

A 56-year-old man with a history of diabetes and coronary artery disease presents to the emergency room with complaints of weakness, fever, and chills. On interviewing the patient, you determine that he went to the dentist about 3 weeks ago and since that time has lost about 5 lb. The patient reports that the symptoms began about 1 to 2 weeks ago. He denies any use of alcohol or illicit drugs but admits to smoking about V2 pack of cigarettes per day. 

The formation of atherosclerotic plaques is the underlying cause of coronary artery disease (CAD) and ACS in most patients. Endothelial dysfunction leads to the formation of fatty streaks in the coronary arteries and eventually to atherosclerotic plaques. Factors responsible for development of atherosclerosis include hypertension, age, male gender, tobacco use, diabetes mellitus, obesity, and dyslipidemia. 

Goal BP values are <140/90 for most patients, but <130/80 for patients with diabetes mellitus, significant chronic kidney disease, known coronary artery disease (myocardial infarction [MI], angina), noncoronary atherosclerotic vascular disease (ischemic stroke, transient ischemic attack, peripheral arterial disease [PAD], abdominal aortic aneurysm), or a 10% or greater Framingham 10-year risk of fatal coronary heart disease or nonfatal MI. Patients with LV dysfunction have a BP goal of <120/80 mm Hg. 

These studies demonstrate that optimal doses of statins reduce the incidence of clinical events in patients with established coronary artery disease, in patients with elevated plasma LDL levels but without existing coronary artery disease, in individuals with normal plasma LDL levels without existing coronary artery disease, and in diabetics, a patient population at high risk of cardiovascular disease. ... 

Many disorders benefit from exercise (Pederson Saltin, 2005). These include asthma, cancer, chronic heart failure, coronary artery disease, chronic obstructive pulmonary disease (COPD), depression, type 1 diabetes melUtus, type 2 diabetes melUtus, hypertension, intermittent claudication, osteoarthritis, osteoporosis, rheumatoid arthritis and obesity. 

As the prevalence of obesity increases worldwide, so does the prevalence of associated co-morbidities type-2 diabetes, chronic obstructive sleep apnoea, cardiovascular disease (hyper-tension, coronary artery disease and congestive heart failure, stroke and peripheral vascular disease), fatty liver disease, various malignancies (Table 7.2), gallstones, subfertility, musculo-skeletal problems and depression. 

In addition to the protective effects of BAS on atherosclerotic plaques and coronary artery disease, a recent study has suggested that BAS could have utility in the management of type-2 diabetes and obesity. 

Deepa R, Deepa K, Mohan V. (2002) Diabetes and risk factors for coronary artery disease. Curr Sci 83 1497-1505. 

Ml-M risk associated with OC use is increased. This risk is primarily in smokers or women with other underlying risk factors for coronary artery disease such as hypertension, hypercholesterolemia, morbid obesity, and diabetes. The risk is very low in women younger than 30 years of age. Long-term use - Data suggest that the increased risk of Ml persists after discontinuation of long-term OC use the highest risk group includes women 40 to 49 years of age who used OCs for 5 years or more. 

Reduction in risk of Ml, stroke, and death from cardiovascular causes - In patients 55 years of age or older at high risk of developing a major cardiovascular event because of a history of coronary artery disease, stroke, peripheral vascular disease, or diabetes that is accompanied by at least 1 other cardiovascular risk factor (eg, hypertension, elevated total cholesterol levels, low FIDL levels, cigarette smoking, documented microalbuminuria). 

Special risk patients Administer with caution to patients with thyroid disease, diabetes mellitus, cardiovascular disease, coronary artery disease, hypertension, peripheral vascular disease, heart disease, ischemic heart disease, increased intraocular pressure, or prostatic hypertrophy. 

And while the data on coronary artery disease are sobering, in many ways they merely represent the tip of the iceberg when considering the prevalence of risk factors for coronary artery disease (Fig. 1.6). Obesity and diabetes are approaching epidemic proportions (Fig. 1.7). Seven out of every ten American adults are considered overweight (BMI > 25) and three out of ten are obese (BMI > 30) [7]. The prevalence of obesity has increased 75%... 

Older patients have predominantly Type 2 diabetes mellitus, which shares with Type 1 the risk for retinopathy, nephropathy and neuropathy, but carries a greater risk for macrovascular complications such as coronary artery disease, stroke and peripheral vascular disease. Many such patients have associated obesity, hypertension and hyperlipidemia, compounding the risk of cardiovascular disease. The goals of treatment of DM in the elderly are to decrease symptoms related to hyperglycaemia and to prevent long-term complications. Treatment of type 2 DM can improve prognosis. In the UKPDS trial, sulphonylureas, insulin, and metformin were all associated with a reduction in diabetes-related... 

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