Dr.

Coronary artery disease accounts for more than 80% of all deaths and 75% of all hospitalizations in diabetic subjects.

Circulation. 2000;102(9):10149. Acta Diabetol. 2002;39 Suppl 2:228.

Mohan et al , J Am Coll Cardiol. 2001;38(3):6827.

Higher mean Intimal Media Thickness Values .

20% of diabetics had carotid atherosclerosis compared to 1% nondiabetics

Mohan et al , Chennai Urban Population Study (CUPS). Diabetologia. 2000;43(4):4949.

Reduced Endothelial function . Higher arterial stiffness.

Ravikumar et al , Am J Cardiol. 2002;90(7):7027.

The identified risk factors for CAD include aging, smoking, and a family history of CAD. Type 2 diabetes is a part of the insulin resistance cluster or metabolic syndrome, which is a combination of hyperglycemia, central body obesity, dyslipidemia, and hypertension . Each of these can contribute independently to the CAD risk or may cluster to increase the risk. Indian J Endocrinol Metab. 2005;7:7285.

.....a strong association of plasma glucose levels with CAD which also means that in Indians, as shown in the West, the clock for CAD starts ticking even at the IGT stage itself. CUPS study

Projections for the whole of India would be 62.4 million people with diabetes and 77.2 million people with pre-diabetes [2011].

Anjana et al ,Diabetologia. 2011 Dec;54(12):3022-7

Mohan et al , Chennai Urban Population Study (CUPS). Diabetologia. 2000;43(4):4949.

Diabetes Prevalence : 34.7%,

Hypertension Prevalence : 46.0%. Diabetes and Hypertension : 20.6%

SITE Study

Joshi et al ,Diabetes Technol Ther. 2012 Jan;14(1):8-15

Young Hypertensives
.. patients under the age of 40 have increased from 10 percent a decade ago to 30 percent today.
Atul Mathur, director of Invasive Cardiology at Fortis Escorts Heart institute

Low prevalence of multiple cardiovascular risk factors (smoking, hypertension, dyslipidemias, diabetes and metabolic syndrome) in adolescents and rapid escalation of these risk factors by age of 3039 years is noted in urban Asian Indians.

BMC Cardiovascular Disorders 2009, 9:28

.data suggests that in Asian Indians, small dense LDL is associated with both diabetes and CAD .

Chennai Rural Epidemiology Study (CURES 8). J Assoc Physicians India. 2005;53:95100.

.Indians have insulin resistance and adiposity even at birth when compared to Caucasians.

Yajnik et al , J Clin Endocrinol Metab. 2002;87(12):557580.

Fibrinolytic factors Lipoprotein[a] Homocysteine Inflammatory markers TNF- , C-reactive Protein , Endothelin -1 ,V-CAM etc.

A multifactorial approach by good control of blood glucose, blood pressure, and serum lipids appears to be necessary to prevent CAD in diabetes patients .
. Lancet. 2001;357(9260):90510. N Engl J Med. 2003;348(5):38393.

Dietary Modification. Regular Physical Activity. Weight Reduction. Cessation of Smoking. Stress Reduction.

Lifestyle modification in the form of diet and regular moderate exercise sharply decreases the likelihood of developing type 2 diabetes in high-risk individuals who have impaired glucose tolerance or impaired fasting glucose.

The effectiveness of this intervention superseded that of metformin therapy.

..Carbohydrate and monounsaturated fat should comprise 60-70% of total calories.

.studies suggest that the protein requirements for people with type 2 diabetes may be slightly greater than those for nondiabetic individuals ..people with diabetes should strive to keep saturated fat consumption to < 7% of total daily calories and to minimize consumption of trans-fatty acids. Cholesterol consumption should be < 200 mg/day. Clinical Diabetes July 2007 vol. 25 no. 3 105-109

For every kilogram of weight loss, there was a 16% reduction in risk, adjusted for changes in diet and activity. .Lower percent of calories from fat and increased physical activity predicted weight loss. ..Increased physical activity was important to help sustain weight loss. Diabetes Care 29:21022107, 2006

 ..nutrients of concern in the diet of vegetarians include vitamin B(12), vitamin D, -3 fatty acids, calcium, iron, and zinc

Nutrient concerns of Vegetarian diets

Craig et al , Nutr Clin Pract. 2010 Dec;25(6):613-20

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 patients with better adherence to exercise and diet [ 400 g/day of Fruits, vegetables and legumes ] showed greater reduction in central obesity and greater decline in cardiac event rates and total mortality
Singh et al , J Am Coll Nutr. 1996 Dec;15(6):592-601.

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Harvard Alumni Study documented that physical inactivity plays a role in CAD BMJ. 2003;326(7404):1419. ..subjects who performed light-grade activity had increased prevalence of not only CAD but also all cardiovascular risk factors compared to subjects who performed heavy-grade activity

Chennai Urban Population Study (CUPS no. 15). Diabet Med. 2005;22(9): 120611.

A comprehensive surveillance system of risk factors and CAD will be an invaluable public health research tool for monitoring population health status, guiding resource allocation and policy, identifying and prioritizing interventions for subpopulations at particular risk, identifying disparities in outcomes, and planning and evaluating health programs.

J Diabetes Sci Technol Vol 4, Issue 1, January 2010