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Coronary Heart Disease in Diabetes

Coronary Heart Disease in Diabetes. Dr Akhil Kapur Consultant Interventional Cardiologist Honorary Senior Lecturer London Chest Hospital Barts and the London NHS Trust. An explosion of diabetes. The Burden of Diabetes Mellitus. Number of people with diabetes in the adult population.

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Coronary Heart Disease in Diabetes

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  1. Coronary Heart Disease in Diabetes Dr Akhil Kapur Consultant Interventional Cardiologist Honorary Senior Lecturer London Chest Hospital Barts and the London NHS Trust

  2. An explosion of diabetes

  3. The Burden of Diabetes Mellitus Number of people with diabetes in the adult population millions millions 350 350 1995 1995 2000 2000 300 300 2025 2025 250 250 200 200 150 150 100 100 50 50 0 0 Developed Countries Emerging Countries Worldwide

  4. US diabetes prevalence in 1994 Source: CDC

  5. US diabetes prevalence in 1996 Source: CDC

  6. US diabetes prevalence in 1998 Source: CDC

  7. US diabetes prevalence in 2000 Source: CDC

  8. US diabetes prevalence in 2002 Source: CDC

  9. US diabetes prevalence in 2004 Source: CDC

  10. Epidemic of diabetes - causes

  11. There’s something wrong with this ….

  12. Causes of death in patients with diabetes Geiss LS et al. In: Diabetes in America 2nd ed. 1995: 233-257

  13. Diabetes and CV mortality % change in age adjusted mortality rate since 1979

  14. Diabetic patients are different Hyperglycaemia Accelerated CAD

  15. Risk Reduction

  16. Reducing cardiac risk in diabetic patients • Good Diabetic control • Treat Blood Pressure • Treat Cholesterol and lipid abnormalities • Treat increased risk of clotting • Lifestyle modifications

  17. What can be done?

  18. School fruit scheme (over 2 million children in 14,000 schools)

  19. Ban on tobacco advertising

  20. The First Diabetic Coronary Disease Clinic

  21. DCD Clinic rationale Patients with diabetes • die from CHD more often • are more difficult to diagnose often presenting with silent ischaemia or atypical symptoms • have more diffuse disease on presentation, with more LV dysfunction often first presenting with an ACS • suffer a more aggressive disease process • receive evidence based standard CHD treatments less often in both acute and clinic settings

  22. Clinic Aims • Allow earlier diagnosis of CHD in diabetic patients even when they present atypically • Commence and optimise evidence based medical therapies • “Fast-track” high risk patients to angiography and appropriate revascularisation

  23. Clinic Structure • Consultant Cardiologist led • DCD Specialist Nurse support • Referral base • General Practice • Endocrinologists • Cardiologists • General medical teams

  24. Our ResultsApril 2007 to April 2009 • 200 consecutive diabetic patients were followed up for 6 months • 105/200 had atypical symptoms on presentation • All patients received exercise, dietary and lifestyle education. • 99% had changes to initial medical therapy

  25. Modifiable Risk Factors

  26. Overall 10 year UKPDS Risk Score

  27. The Future • DCD clinic in every NHS trust ??? • Asymptomatic diabetic patients

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