Diabetes in the elderly
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Corresponding author Angela Botts, MD Beth Israel Deaconess Medical Center, 110 Francis Street, LMOB 1B, Boston, MA 02215, USA. E-mail: [email protected] Current Cardiovascular Risk Reports 2008, 2:382 –389 Current Medicine Group LLC ISSN 1932-9520 Copyright © 2008 by Current Medicine Group LLC
The association of diabetes and cardiovascular disease is a major health concern in the elderly population. Patients 65 years of age or older with diabetes have a greater risk of ischemic heart disease and cardiovascular mortality than nondiabetic patients of the same age. In addition, although there has been an overall reduction in cardiovascular disease morbidity and mortality in the United States over the past 50 years, the burden of cardiovascular disease attributable to diabetes mellitus has actually increased over this time. In addition to traditional risk factors (eg, hypertension, dyslipidemia), the effect of nonclassical cardiovascular risk factors, such as exogenous and endogenous insulin, metabolic syndrome, impaired fasting glucose, chronic kidney disease, advanced glycation end products, and adipokines, in elder patients with diabetes is currently being evaluated. This article addresses current evidence related to cardiovascular risk in elderly patients with diabetes.
Introduction The association of diabetes and cardiovascular disease (CVD) is a major health concern in the elderly population. The impact will increase dramatically over the next several years with the aging of the American population. By 2020, it is estimated that the US population of people 65 years of age and older will increase to 55 million and then skyrocket to approximately 87 million by 2050 [1]. Currently, elderly people account for almost 40% of patients with diabetes, and it is estimated that 6.9% of adults 65 years of age or older have undiagnosed diabetes [2 , 3]. By age 85, nearly 75% of individuals have evidence of insulin resistance or frank diabetes [4]. Diabetes is currently the most prevalent risk factor for CVD in the United States [5]. Patients with type 2 diabetes are two to four times more likely to develop CVD than nondiabetic patients, with up to 80% of these patients developing macrovascular disease [6,7 ].
The important relationship between diabetes and cardiovascular risk is well documented and has a significant clinical impact for the elderly. This article reviews the current evidence regarding the epidemiology of CVD in elderly patients with diabetes mellitus, the mechanisms and risk factors underlying the increased risk of CVD in diabetes mellitus, and the recent advances in management of elderly patients with diabetes for optimal risk reduction.
Epidemiology of CVD in the Elderly with Diabetes Mellitus Diabetes is a strong independent risk factor for CVD unrelated to other risks, including smoking, hypertension, and hypercholesterolemia [8,9]. In addition, patients 65 years of age or older with diabetes have a two times greater risk of ischemic heart disease than nondiabetic individuals of the same age [2]
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