Cardiovascular burden of diabetes mellitus: a review

Abstract

Background: The incidence of diabetes mellitus (DM) is rapidly on the increase worldwide and is gradually becoming a major public health problem for developing nations. Diabetes in all its forms is one of the main cardiovascular risk factors. Cardiovascular complications are a leading cause of death in diabetic patients and this has the potential to place a large social and economic burden on a developing country like ours, as cardiovascular diseases tend to strike those in their prime. 
Aim: To review the cardiovascular burden of diabetes mellitus.
Methods:  A review of the literature was done using google search, hinari, pubmed and books from the author's collection. Keywords/ phrases used in the search included diabetes mellitus, cardiovascular diseases, cardiovascular complications of diabetes mellitus.
Results: Diabetes mellitus affects the heart in four main ways; autonomic neuropathy, more severe coronary artery disease, diabetic cardiomyopathy and microangiopathy. DM increases the risk of coronary artery disease more in women than men. It negates the protective female hormonal advantage in cardiovascular disease so that the risk of cardiovascular death is equal in both sexes in diabetic patients. In type 2 diabetes autonomic dysfunction impairs exercise tolerance, reduces response in heart rate and blood pressure thus blunting the cardiac output in response to exercise. Cardiovascular autonomic neuropathy is associated with prolonged QT interval and may predispose to malignant ventricular arrhythmias. Left ventricular diastolic dysfunction characterised by increased ventricular stiffness, delayed relaxation of the left ventricle and increased left ventricular mass is also associated with an increased morbidity and mortality in diabetic patients.   
Conclusions: Diabetes mellitus and related cardiovascular complications are a major public health burden worldwide and are especially on the increase in Africa even as the continent adopts a more westernised lifestyle. 

Keywords: Diabetes mellitus, Cardiovascular diseases,  Africa