The document discusses the relationship between diabetes and cardiovascular disease. It notes that diabetes increases the risk of cardiovascular problems like heart disease and stroke. Insulin resistance is associated with atherosclerosis and often precedes the development of type 2 diabetes. The document also outlines complications of diabetes like kidney disease and discusses the increased cardiovascular risks for women with diabetes.

4. Insulin Resistance and Atherosclerosis: Posited Relationships Accelerated atherosclerosis Clinical diabetes Hyperinsulinemia Impaired glucose tolerance Hypertriglyceridemia Decreased HDL-C Essential hypertension Insulin resistance

7. Framingham Heart Study 30-Year Follow-Up: CVD Events in Patients With Diabetes (Ages 35-64) 10 9 20 11 9 6 38 19 3* 30 0 2 4 6 8 10 Age-adjusted annual rate/1,000 Men Women Total CVD CHD Cardiac failure Intermittent claudication Stroke Risk ratio P <0.001 for all values except * P <0.05.

8. Risk Similar in Patients With Type 2 Diabetes and No Prior MI vs Nondiabetic Subjects With Prior MI Haffner SM et al. N Engl J Med. 1998;339:229-234. 0 1 2 3 4 5 6 7 8 0 20 40 60 80 100 Nondiabetic subjects without prior MI (n=1,304) Diabetic subjects without prior MI (n=890) Nondiabetic subjects with prior MI (n=69) Diabetic subjects with prior MI (n=169) Survival (%) Year

14. Abnormal Lipid Levels in Men With Type 2 Diabetes 14 9 26 11 12 13 9 21* 34* 19* 0 10 20 30 40 50 Men without diabetes Men with diabetes TC  260 TG  235 VLDL-C  40 LDL-C  190 HDL-C  31 Prevalence (%) * P <0.05. LRC approximate 90th percentile age- and sex-matched values, except for HDL-C (10th percentile).

15. Abnormal Lipid Levels in Women With Type 2 Diabetes 21 8 31 16 10 24 38 15 25* 17* 0 10 20 30 40 50 Women without diabetes Women with diabetes TC  275 TG  200 VLDL-C  35 LDL-C  190 HDL-C  41 Prevalence (%) * P <0.05. LRC approximate 90th percentile age- and sex-matched values, except for HDL-C (10th percentile).

22. Primary CHD* Prevention in Patients With Type 2 Diabetes: The Helsinki Heart Study 7.4 3.3 10.5 3.4 0 5 10 15 Type 2 (n=135) Others (n=3,946) Type 2 on placebo (n=76) Type 2 on gemfibrozil (n=59) 5-Yr incidence of CHD (%) *Myocardial infarction or cardiac death. NS=not significant. Koskinen P et al. Diabetes Care. 1992;15:820-825. P <0.02 P =NS

23. Total mortality 232 167 24 15 CHD mortality 172 99 17 12 Major CHD event 578 407 44 24 Any CHD event 871 667 56 41 CABG or PTCA 363 238 20 15 Cerebrovascular event 90 70 12 5 Any atherosclerotic event 961 750 61 46 Nondiabetic Diabetic P S 0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 RR with 95% CIs No. patients Simvastatin Placebo with events better better