The cause of diabetes mellitus is metabolic in origin. However, its major clinical manifestations, which result in most of the morbidity and mortality, are a result of its vascular pathology. In fact, the American Heart Association has recently stated that, "from the point of view of cardiovascular medicine, it may be appropriate to say, diabetes is a cardiovascular disease" (1). But diabetic vascular disease is not limited to just the macrovasculature. Diabetes mellitus also affects the microcirculation with devastating results, including nephropathy, neuropathy, and retinopathy. Diabetic nephropathy is the leading cause of end-stage renal disease in the United States, while diabetic retinopathy is the leading cause of new-onset blindness in working-age Americans.
The importance of this text on Diabetes and Cardiovascular Disease is evident by the magnitude of the population affected by diabetes mellitus. Over 10 million Americans have been diagnosed with diabetes mellitus, while another 5 million remain undiagnosed. The impact from a public health perspective is huge and increasing. As the population of the United States grows older, more sedentary, and obese, the risk of developing diabetes and its complications will increase.
Epidemiological studies have identified diabetes mellitus as a major independent risk factor for cardiovascular disease. Over 65% of patients with diabetes mellitus die from a cardiovascular cause. The prognosis of patients with diabetes mellitus who develop overt clinical cardiovascular disease is much worse than those cardiovascular patients free of diabetes mellitus.
The 24 chapters of Diabetes and Cardiovascular Disease focus on either clinical or basic aspects of diabetes and cardiovascular disease. Part I, Pathophysiology, reviews the mechanisms and risk factors for diabetic cardiovascular disease. Part II focuses on the heart in diabetes mellitus, including coronary artery disease and congestive heart failure. The peripheral vascular system is the subject of Part III, which addresses epidemiology, mechanisms, methods of assessment, and treatment of this macrovascular disease. Lastly, Part IV reviews the different microvascular effects in individuals with diabetes mellitus, including retinopathy, nephropathy, neuropathy, and microcirculation of the diabetic foot.
The aim of Diabetes and Cardiovascular Disease is to serve as a comprehensive review of both the basic and clinical aspects of diabetic vascular disease for the practicing clinician. The readership will include cardiologists, general internists, vascular specialists, family physicians, and medical students, along with other interested practitioners and allied health personnel. The text is also directed toward both clinical and basic research scientists, and emphasis has thus been given to both theoretical and practical points. Each chapter covers its topics in great detail and is accompanied by extensive references.
We are indebted to the many people who worked on this volume. In particular, we wish to thank those talented and dedicated physicians who contributed the many chapters in this text. We were fortunate to have the collaboration of a group of authors who were among the most prominent in their respective fields. We hope that our efforts will serve as a stimulus for further research in this increasingly important health concern.
We want to extend our deepest appreciation to Paul Dolgert and Craig Adams of Humana Press for guiding us through the preparation of this book. As well, we want to give a special thanks to Dr. Christopher Cannon, who saw the need for such a volume and gave us the opportunity to edit this text.
Michael T. Johnstone, md Aristides Veves, md, dsc reference
1. Grundy SM, Benjamin IJ, Burke GL, et al. AHA Scientific Statement-Diabetes and Cardiovascular Disease. Circulation 1999;100:1134-1146.
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