A 53-year-old woman comes to the physician for a routine check-up. She has no current complaints. Her past medical history is significant for osteoarthritis of the right knee. Her mother suffered from hypertension and was diagnosed with breast cancer at age 68, from which she died 4 years later. Her father had diabetes mellitus and died in a motor vehicle accident at age 56. The patient's blood pressure is 140/85 mm Hg and heart rate is 80/min. Physical examination is normal. Laboratory testing is significant for a fasting blood glucose level of 140 mg/dL on more than 2 occasions. This patient is most likely to die from which of the following conditions?
Risk factors for coronary heart disease | |
| Highest risk factors (coronary heart disease equivalents) |
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| Major risk factors |
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Several studies have shown that diabetes mellitus is one of the strongest risk factors for coronary heart disease. Cardiovascular mortality is increased by 2- to 4-fold in patients with type 2 diabetes mellitus, and approximately 40% of patients die secondary to coronary heart disease. For a person with type 2 diabetes mellitus, the risk of dying from coronary heart disease exceeds the risk of dying from any of the other listed causes, even in the absence of other major risk factors for coronary heart disease.
(Choice A) The risk of breast cancer is not increased in patients with diabetes mellitus. Although this patient has a family history of breast cancer, her risk is not significantly increased since her mother was at an advanced age when the cancer occurred.
(Choice B) Diabetic ketoacidosis (DKA) and hyperosmolar coma are acute complications of untreated diabetes mellitus. Hyperosmolar coma is seen mainly with type 2 diabetes mellitus and is characterized by very high blood sugar levels without ketoacidosis. The mortality of hyperosmolar coma is higher than DKA; however, very few patients with diabetes die directly from DKA or hyperosmolar coma.
(Choice D) Diabetes mellitus is the leading cause of end-stage renal disease (ESRD), followed by hypertension. However, approximately 50% of patients with ESRD die due to cardiovascular disease, with infections being the next most common cause.
(Choice E) The risk of stroke is increased in patients with diabetes mellitus. However, cerebrovascular accidents account for about 10% of total mortality in patients with type 2 diabetes mellitus versus 40% from coronary heart disease.
Educational objective:
Patients with noncoronary atherosclerotic disease, diabetes mellitus, or chronic kidney disease are at the same risk of cardiovascular events (eg, myocardial infarction, stroke) as patients with known coronary heart disease. Coronary heart disease is the most common cause of death in patients with diabetes mellitus.