The Heart in Diabetes [antikvár]

Preface Diabetes is a major public health problem which is expected to affect 160 million people world wide by the year 2000. During the past 70 years the average life expectancy of diabetic patients has significantly increased; however, it is still substantially lower than the general population. Prior to the discovery of insulin the primary causes of death for people with diabetes were diabetic coma, infections and cardiovascular disease. The use of insulin has almost eliminated death from diabetic coma and dramatically decreased death from infections; consequently cardiovascular disease is now the leading cause of death in the diabetic population. Although cardiovascular disease remains the leading cause of death for the general population, diabetic patients have greatly increased risks of heart failure and coronary artery disease compared to non-diabetics. Furthermore, survival rates following acute myocardial infarction are markedly lower than the general population. Until recently the elevated risk of cardiovascular disease was presumed to be a direct consequence of the increased incidence of atherosclerosis in diabetes. Several decades of epidemiological and experimental research has suggested that there is a specific diabetes-induced cardiomyopathy that is independent of other risk factors for heart disease, such atherosclerosis and hypertension. Despite the impact of heart disease in limiting the quality and longevity of life for diabetic patients, there is no consensus as to the pathophysiologic alterations that are involved. Clearly an understanding of the effects of diabetes on the heart is an important step in the development of strategies to reduce the incidence of heart disease for diabetic patients, thus increasing their overall life-expectancy and quality of life. In this book we bring together the different lines of evidence supportive of the idea of a diabetic cardiomyopathy. The first chapter provides an overview of the impact of cardiac dysfunction on the mortality and morbidity of the diabetic population in general, as well as a presentation of clinical aspects of heart disease in diabetes. This is followed by chapters concerned with the pathological and functional changes that occur in the heart as a result of diabetes and a description of the various therapeutic