The Relationship of Cardiovascular Disease to Hyperglycemia

THE HIGH PREVALENCE OF vascular dis-ease among diabetics has long been recognized and has become increasingly important since the acute complications of diabetes, acidosis, and infection have been controlled. With a longer life span cardiovascular disease is now the major complication of diabetes. Only 17 % of dia-betics died of vascular disease in 1914, but by 1957 it was the cause of death in 77% of the patients in one large series (1). Be-sides the well-known capillary lesions, the vascular complications have included coro-nary and peripheral atherosclerotic occlu-sive disease, hypertension, and cerebrovas-cular disease. The higher prevalence and greater se-verity of coronary atherosclerosis among hospitalized diabetics in contrast to non-diabetic patients has been demonstrated in several reports based upon autopsy mate-rial (2-6). Bryfogle and Bradley (7) re-ported evidence of arteriosclerotic heart disease in 56.2 % of 394 hospitalized dia-betics past 40 years of age. The same au-thors attributed half of all the deaths in their series to coronary occlusive disease (8). Although patients admitted to a hos-pital would be expected to have a higher prevalence of serious vascular disease, Lie-bow, Hellerstein, and Miller (9) reported that 42 % of their 303 diabetic clinic pa-tients had arteriosclerotic heart disease. Coronary artery disease as a cause of death among diabetics at the Joslin Clinic in-creased from 6.1 % for the period from 1898 to 1914 to 47.6 % for the years 195