This document discusses the double burden of diabetes mellitus (DM) and cardiovascular disease (CVD) in Egypt and globally. It notes that Egypt has one of the highest rates of DM in the world, with prevalence increasing rapidly from 4.4 million cases in 2007 to a projected 13.1 million cases by 2035. DM greatly increases the risk of CVD through endothelial dysfunction and is a major risk factor for both microvascular and macrovascular complications. The pathophysiology of CVD in DM involves accelerated atherosclerosis driven by hyperglycemia, insulin resistance, inflammation, and diabetic dyslipidemia. Strategies are needed to better control DM and decrease its impact on CVD.

1. DM & CVD
the double
trouble
AhmedMagdyMostafa,MD
Lecturerofcardiology
ArmedForcescollegeof Medicicne

2. Global burden of DM

6. DM in Egypt

7. DM in Egypt
– The International Diabetes Federation (IDF) listed Egypt among the world top
10 countries in the number of patients with diabetes.
– In Egypt, the prevalence of diabetes is around 15.56% among adults between
20 and 79 years of age, with an annual death of 86,478 related to diabetes.
– Furthermore, reports indicate that 43% of patients with diabetes and most
patients with prediabetes in Egypt are likely undiagnosed.
– It is alarming that diabetes prevalence in Egypt has increased rapidly within a
relatively short period from approximately 4.4 million in 2007 to 7.5 million in
2013. It is expected this number will jump up to 13.1 million by 2035

9. DM & CVD

10. Prevalence of cardiovascular disease
in younger people with type 1 diabetes

11. Prevalence of cardiovascular disease in middle-
aged people with diabetes

12. Cardiovascular disease mortality in
middle-aged people with diabetes

13. Key manifestations of CV disease
1. World Health Organization 2015: http://www.who.int/cardiovascular_diseases/en/cvd_atlas_01_types.pdf?ua=1
2. http://www.heart.org/HEARTORG/Caregiver/Resources/WhatisCardiovascularDisease/What-is-Cardiovascular-Disease_UCM_301852_Article.jsp#
Peripheral
arterial disease
Disease of blood vessels
supplying arms and legs1
Coronary
heart disease
Disease of blood vessels
supplying heart muscle1
Stroke
Caused by disruption of
blood supply to the brain1
Heart failure
Failure of the heart to pump
blood with normal efficiency
(sometimes called congestive
heart failure)2

14. Years from
diagnosis
0 5
-10 -5 10 15
Onset Diagnosis
Insulin secretion
Sources:
Ramlo-Halsted BA et al. Prim Care. 1999;26:771-789
Nathan DM et al. NEJM 2002;347:1342-1349
Fasting glucose
Insulin resistance
Microvascular complications
Macrovascular complications
Type II diabetes
Pre-diabetes
Postprandial
glucose
Natural History of Type II Diabetes Mellitus

15. DM is a major and independent risk factor for both
microvascular and macrovascular complications
1. World Health Organization. http://www.who.int/diabetes/action_online/basics/en/index3.html
Macrovascular
Microvascular

16. Endothelial dysfunction is common to
microvascular and macrovascular events
1
6 Versari et al. Diabetes Care 2009;32(suppl 2):S314-321.
Normal conditions Risk factors Subclinical organ factors Clinical events
Remodelling – hypertrophy
Remodelling – plaque
Microalbuminuria/mild insufficiency
Endothelial function
Myocardial infarction
Heart failure
Peripheral artery disease
TIA, stroke
Aortic aneurism
Overt proteinuria
End-stage renal failure

17. Pathophysiology of CVD in DM

18. Endothelial dysfunction drives atherosclerotic
progression
Figure adapted from Libby. Circulation 2001;104:365‒72.
Zeadin et al. Can J Diabetes 2013;37:345e350.
Atherosclerosis is accelerated in T2D by hyperglycaemia, insulin resistance,
inflammation and diabetic dyslipidaemia

21. How can we reach the targets?

22. Strategies to decrease the impact of diabetes
and cardiovascular diseases

23. Medications

24. Thank you