Diabetes and Cardiovascular Disease

Correspondence: Dr. V. Fuster. The Zena and Michael A Wiener Cardiovascular Institute and The MarieJosee and Henry R Kravis Center for Cardiovascular Health. Mount Sinai School of Medicine. Box 1030, One Gustave L Levy Place, New York, NY 10029-6574, USA. E-mail: [email protected] Cardiovascular disease is the leading cause of mortality and morbidity in developed countries. Diabetes Mellitus is a major risk factor for cardiovascular disease, contributing to its devastating economic consequences. Metabolic syndrome and abdominal obesity are an increasing health problem, often linked to diabetes (and glucose intolerance). Opposed to subcutaneous, intra-abdominal fat deposition results in a series of deleterious mechanisms, including the release of inflammatory markers that contributes to the high incidence of cardiovascular disease in this population. In fact, it is clear that inflammation is a major player in obesity, metabolic syndrome, and diabetes, not only contributing to these conditions, but also being a link between them. Indeed, several pathways suggest interaction between the metabolic and immune-inflammatory system, indicating that these processes are not different mechanism but different manifestation of the same process. Cardiovascular, noninvasive imaging has emerged as an accurate tool for assessing burden of atherosclerosis. Magnetic resonance imaging has been revealed as an accurate tool to assess the burden of disease (in extracoronary territories). However, the understanding of the mechanism involved in plaque development, inflammation and instability has led to the concept of functional imaging (in addition to the “classical” anatomical imaging). Inflammation within the atherosclerotic plaque can be quantified by 18F fluorodeoxyglucose positron-emission tomography. Much hope is placed on the role of this new merged imaging modality for the diagnosis of high risk plaques and for the treatment monitoring. Finally, new advances in molecular imaging using targeted contrast agents have permitted the noninvasive characterization of plaque composition both by magnetic resonance imaging and by computed tomography.