Cardiovascular disease predicts diabetic peripheral polyneuropathy in subjects with type 2 diabetes: A 10-year prospective study.

BACKGROUND: The relationship between cardiovascular disease and diabetic peripheral neuropathy is mainly sustained by data retrieved from cross-sectional studies focused on cardiovascular risk factors. We aimed to assess the presence of cardiovascular disease as a risk factor for developing diabetic peripheral neuropathy in a type 2 diabetes mellitus population. METHOD: A 10-year prospective, primary care, multicentre study in a randomly selected cohort. Cardiovascular disease presence included stroke, coronary artery disease and/or peripheral ischaemia. Diabetic peripheral neuropathy diagnosis was based on clinical neurological examination as well as the neuropathy symptoms score and nerve conduction studies. RESULTS: Three hundred and ten (N=310) patients were initially recruited. Two-hundred and sixty seven (N=267) patients were included in the study. Diabetic peripheral neuropathy cumulative incidence was 18.3% (95% confidence intervals 14.1-23.4; N=49). Diabetic peripheral neuropathy development was significantly more frequent in participants presenting with cardiovascular disease at baseline (P=0.01). In the final logistic regression analysis, the presence of cardiovascular disease remained associated with an increased risk for diabetic peripheral neuropathy (odds ratio 2.32, 95% confidence intervals 1.03-5.22) in addition to diabetes duration and low density lipoprotein-cholesterol levels. CONCLUSIONS: In our series, type 2 diabetes mellitus patients with cardiovascular disease at baseline present with an increased risk of developing diabetic peripheral neuropathy at 10 years of follow-up. Our results suggest that measures aimed at the prevention, control and treatment of cardiovascular disease can also help prevent diabetic peripheral neuropathy development.

Obesity and cardiovascular disease.

BACKGROUND: The prevalence of obesity has reached epidemic proportions, and in terms of the extent of its negative impact on the health has been compared to those of tobacco and alcohol. One of the first medical consequences of obesity to be recognised was cardiovascular disease (CVD). Obesity, particularly abdominal obesity, predisposes a person to a number of other cardiovascular risk factors, and is an independent predictor of clinical CVD including coronary death, coronary heart disease, heart failure and stroke. MATERIALS AND METHODS: A Medline search using the following keywords (obesity, cardiovascular disease, body mass index, cardiovascular risk factors, type 2 diabetes, metabolic syndrome) was performed looking for high impact factor English-written references. RESULTS: Ninety-nine (N=99) relevant articles published in the last 15 years were selected and commented. As detailed throughout the text, current therapies available for weight management can improve or prevent many of these obesity-related risk factors for CVD. However, there is some controversy as to whether weight loss is beneficial for health, and large clinical outcome trials such as the Look-AHEAD (Action for Health in Diabetes) trial or the SCOUT (Sibutramine Cardiovascular Outcomes Trial) study are currently ongoing. DISCUSSION: In the present review, we summarise the effects of obesity as well as the efficacy of weight-loss interventions on cardiovascular risk factors and CVD.