Why are Indian diabetic subjects more prone to coronary artery disease?

Diabetes is expanding in pandemic proportions worldwide. Escalation in prevalence of diabetes appears to be more pronounced in developing countries, particularly in India. Presently more than 30 million people are affected by diabetes in India. These numbers are expected to increase to 80.9 million by year 2032. In addition, the emergence of the coronary artery disease (CAD) epidemic in India has added to the economic and health burden of the nation. Various epidemiological studies have consistently reported high prevalence rates of diabetes and CAD among migrant Indians compared to the native population. The risk for CAD among diabetic subjects is greater by a factor of 2 to 4 compared to non-diabetic subjects. The results of the Chennai Urban Population Study (CUPS) revealed that overall 11% of the total population studied had CAD, which is 10 times higher compared that reported 40 years ago. 21.4% of the diabetic subjects and 14.9% of the subjects with impaired glucose tolerance had CAD compared to 9.1% among subjects with normal glucose tolerance. The pathophysiological process of atherosclerosis in diabetic subjects is accelerated by several factors such as hyperglycemia, insulin resistance, abnormal lipid profile, oxidative modification of lipoproteins, increased blood pressure, altered rate of fibrinolysis etc. The article focuses on the role of traditional and newer cardiovascular risk factors in association with diabetes