CoRonARy HeART DIseAse In Type 2 DIAbeTes: epIDeMIoLogy AnD MeCHAnIsMs

Coronary heart disease is the single largest cause of death in India and causes large premature mortality and morbidity. Risk factors include smoking, tobacco use, high blood pressure, diabetes, high LDL cholesterol, low HDL cholesterol and sedentary lifestyle. Diabetes is a major cardiovascular risk factor and is epidemic in India. Atherosclerotic vascular disease is the major cause of mortality and morbidity in patients with type 2 diabetes. More than 60 % patients of type 2 diabetes die of coronary heart disease and type 2 diabetes is a major cardiovascular risk factor and in India more than 60 % patients with coronary heart disease have diabetes or glucose intolerance. There are macrolevel as well as microlevel mechanisms linking the two diseases. At a macrolevel the sociological (rapid urbanization, rapid affluence), demographic (increased aging) and epidemiological factors (sedentary lifestyle, improper excessive dietary intakes, psychosocial stress and obesity/adiposity) are similar in the two diseases while microlevel vascular factors are common. Mechanistic features unique to type 2 diabetes are vascular effects of hyperglycemia, diabetic dyslipidemia (elevated and/or dysfunctional triglycerides, low density lipoproteins and high density lipoproteins) as well as chronic inflammatory response to hyperglycemia and abnormal adipocytes. Further research to elucidate mechanisms of premature diabetes related vascular disease, that is unique to India, is required