Diabetes and Atherosclerosis.

Diabetes and Atherosclerosis. – book reviews

Robert Tattersall

There is overwhelming clinical and epidemiological evidence that atherosclerosis occurs prematurely in people with diabetes, causing high rates of heart attack, strokes and peripheral vascular disease. Part of the increased risk can be explained by concomitant obesity, hypertension or hyperlipidaemia, but in multivariate analyses diabetes always shows up as an independent risk factor. Unlike microvascular complications, the incidence of large-vessel disease is not linearly related to the blood sugar level, the duration of diabetes or method of treatment. This suggests that hyperglycaemia is not the cause and there is increasing evidence that hyperinsulinaemia, as Stout himself first suggested in 1969, is the villain of the piece.

This book is a mine of information on the complex interrelationship between atherosclerosis and the metabolic abnormalities which accompany diabetes such as hyperinsulinaemia, hyperlipidaemia, differential insulin resistance, hypertension, glycation etc. The topics covered are largely theoretical, although there are useful discussions of the pros and cons of various lipid-lowering and blood pressure-lowering drugs in diabetes; but in neither chapter (not surprisingly) do the authors give guidelines on which patients should be treated or how one decides whether it is more important in the individual to treat blood sugar, blood pressure or lipids. There is also a short but useful chapter on the woolly subject of nonischaemic heart disease in diabetes (‘diabetic cardiomyopathy’): we know this must exist because neither ischaemic heart disease nor hypertension account for the increased prevalence of heart failure in diabetic patients observed in virtually every study. The chapter which is least relevant to the subject of the book is that by Keith Buchanan on gastrointestinal hormones, but I can understand why the editor included it because it is a fascinating, concise and authoritative review of an ever-expanding subject. I confess to never having heard of GLP-1 7-36, a glucagon-like peptide which stimulates insulin release but suppresses glucagon. This sounds an ideal combination of effects and we shall have to wait and see whether this hormone or a modification of it is ever marketed for the treatment of non-insulin-dependent diabetes.

The strength of this book, apart from the wealth of information it contains, is that, although there are 12 contributors (which hardly justifies the term multi-author, when a diabetes textbook published in the same year has 172!), they all hail from Belfast and blend together very well, as members of a good team should. Unfortunately, the price will put this book out of the range of most individuals but I can thoroughly recommend it to cardiologists, diabetologists, endocrinologists, general physicians, geriatricians, pathologists and vascular surgeons.

COPYRIGHT 1993 Oxford University Press

COPYRIGHT 2004 Gale Group