Macrovascular complications: Coronary artery disease

Coronary artery disease (CAD) is a leading cause of morbidity and mortality worldwide. Diabetes Mellitus (DM) is considered the CAD equivalent by major cardiovascular (CV) societies around the world. People with diabetes (PWD) do not uncommonly present with atypical symptoms of CAD. Silent myocardial infarction (MI) is defined as evidence of MI in the absence of symptoms. Various studies have shown poor outcomes for patients with silent acute MI. PWDs with chronic kidney disease (CKD), microalbuminuria, autonomic neuropathy, and dyslipidemia are at higher risk for CAD. Various testing modalities have been studied for screening purposes, including resting and stress electrocardiograms (EKG) and echocardiograms, computed tomography (CT), and invasive coronary angiograms. Management encompasses aggressive risk factor reduction, lifestyle modifications, pharmacological therapies, and invasive revascularization where indicated. CAD and diabetes are interdependent when it comes to prognosis. These two entities independently predict outcomes for each other. The presence of diabetes in CAD is associated with a two- to fourfold increased risk of CV mortality.