Detection and diagnosis of heart disease in diabetic and prediabetic subjects

Cardiovascular diseases account for a major component of the morbidity and mortality affiicting patients with diabetes. Nearly 77% of all hospitalizations attributable to medical complications in patients with diabetes are cardiovascular in nature. Cardiovascular disease event rates and mortality among patients with diabetes are on the rise, although they are decreasing in individuals without diabetes (1,2). The effect of diabetes on the heart includes a wide spectrum of abnormalities that extends from subtle subclinical findings to overt clinical manifestations that may be considered under three broad categories: (1) coronary atherosclerosis; (2) diabetic cardiomyopathy; and (3) diabetic autonomic neuropathy. There is growing evidence that an early and tailored management strategy can limit or slow down the progression of diabetic heart disease and may also potentially reduce the cardiovascular event rate in this group of patients (3). This underscores the need for early and accurate detection of the manifestations of heart disease in patients with diabetes. This chapter summarizes the various diagnostic tools that are available to the clinician for the diagnosis of diabetic heart disease, and their value and utility in clinical practice. This chapter does not attempt to consider independently the important differences among patients with type 1 and type 2 diabetes, but rather addresses patients with diabetes in general, specifically referring to either type when issues unique to them are discussed.