The changing face of macrovascular disease in non-insulin-dependent diabetes mellitus: an epidemic in progress

Cardiovascular disease (CVD) is the most common complication of non-insulin-dependent diabetes mellitus (NIDDM) in Europeans,“z and accounts for at least 66% of deaths in NIDDM patients.3 People with diabetes have a risk of CVD two to five times that of nondiabetic individuals.‘,‘,’ Macrovascular disease, in both diabetic and nondiabetic people, was thought to be rare in developing countries that are undergoing large cultural transitions, but there is now evidence that this theory may need revision.ls5 The main implication of macrovascular diabetic disease, from the public-health perspective, is the human distress and disability associated with it, and the socioeconomic costs from premature morbidity and mortality.” Although CVD risk is consistently increased in people with diabetes, it reflects the prevalence of CVD in the non-diabetic members of that population.‘Thus, even in a low-prevalence nation, such as Japan, a person with diabetes has a CVD risk twice that of the non-diabetic person. This risk, however, is still only a fraction of the risk of a non-diabetic person from a western culture.’ But exposure to ‘westernised’ environments rapidly raises the atherosclerotic risk in people from lowprevalence nations.’ Most of the increase in atherosclerotic risk has occurred in newly industrialised nati0ns.Q’ These findings call for a reassessment of the impact of macrovascular complications, since they were rare in these populations when they lived a ‘traditional’ way of life.5,8