Atherogenesis in Diabetes

A bout 45 years ago George Lyman Duff, together / \ with Gardner McMillan, presented a paper J. \ . called "The Effect of Alloxan Diabetes on Experimental Cholesterol Atherosclerosis in the Rabbit" at the Second Annual Meeting of the American Society for the Study of Arteriosclerosis, and two papers describing that work were subsequently published in the Journal of Experimental Medicine in 1949. Since the initiation of the George Lyman Duff Memorial Lecture 35 years ago, this is the first one devoted to atherosclerosis and diabetes, a subject obviously close to Dr. Duff's interest. The importance of atherosclerosis in diabetes is clear. Since the beginning of the insulin era, the proportion of total deaths from coronary heart disease (CHD) in diabetes has progressively increased to the point where now almost three fourths of deaths among diabetics are directly attributable to CHD. Recent data from the Joslin Clinic indicate that by age 50, fully one third of male and female individuals with insulin-dependent diabetes mellitus (IDDM) have already died from CHD, a proportion far exceeding that observed in an age-matched nondiabetic cohort. Although CHD mortality cannot be directly equated with atherogenesis, such data are compelling nevertheless.