Atherosclerotic vascular disease and diabetes in the older adult Part I: Understanding pathogenic mechanisms and identifying risk factors

The first part of this two-part article summarized the epidemiologic impact of ASVD in the older adult with diabetes, the pathogenic mechanisms of atherosclerosis, and the numerous traditional and nontraditional risk factors that accelerate atherogenesis. In the case patient, RS, risk factors for ASVD include age, obesity, hypertension, diabetes, and laboratory data that showed an LDL-C of 145 mg/dL and an elevated microalbumin/Cr ratio. Although the likelihood of subclinical or preexistent CVD in this patient is high (> 40%), studies have documented that patients such as RS in the 8th decade of life with longstanding diabetes can still benefit from the intensive and simultaneous treatment of multiple risk factors. As current estimates i ndicate that 88% of older persons with diabetes have either established or subclinical CHD, the importance of diabetes-related ASVD and its impact on the older population cannot be overstated. Part II of this article will discuss the rationale and strategies for treatment of ASVD in the older person with diabetes, and provide an easy-to-remember checklist to help busy clinicians implement this approach.