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Saturday, November 24, 2007

Cardiovascular Disease

Compared with men of the same age, nondiabetic women seem to have a degree of protection from diseases of the heart and blood vessels until they reach menopause. Women with diabetes seem to lose this relative protection and at all ages are at increased risk of developing or dying from coronary artery disease, congestive heart failure, strokes, and peripheral vascular disease. Cigarette smoking, hypertension, and obesity all magnify these risks.

In some cases women with diabetes are at higher risk than men with diabetes of the same age. The risk of dying from heart disease, for example, is higher for women than for men, though both men and women with the disease have a higher risk of dying from these problems than do people in the general population. This is partly because their blood vessels are often extensively damaged and partly because their heart attacks may involve unusual symptoms that make them harder to detect.

Certain operations commonly performed on patients with heart disease may be especially risky for women with diabetes. For example, coronary artery bypass surgery tends to be less successful in women in general, possibly because they have smaller blood vessels than men or because they tend to be diagnosed later in the course of coronary artery disease. Some studies suggest that bypass surgery may be even less effective and riskier in women with diabetes. IF this turns out to be true, it may have something to do with the nature of the fatty deposits in the arteries of women with diabetes.

Whether diabetic women develop more complications from 'balloon surgery' than do nondiabetic women or diabetic men is not known. This is a procedure used to open narrowed or blocked coronary arteries by threading a balloon-tipped device through the arteries to the place of blockage and then inflating it.

Estrogen replacement therapy(ERT) in postmenopausal women, especially those with diabetes, may help reduce the risk of some forms of cardiovacular disease. Preliminary evidence suggests that ERT may slightly improve glucose control in women with diabetes, and it has beneficial effects on cholesterol levels, which when elevated in diabetics, compound the risk of heart disease.

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