CARDIAC RISK FACTORS IN HISPANICS WITH TYPE 2 DIABETES

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Cardiovascular disease (CVD) is the most common cause of both morbidity and mortality in Type 2 diabetic individuals. Diabetic women have shown to have a comparable incidence of CVD mortality with diabetic men, regardless of age. Apparently, the "protective" effects of estrogen observed in non-diabetic women are not observed in diabetic women. Hispanics have shown an increasing incidence rate of CVD that is nearly all accounted for by diabetes. Hispanic women with poorly controlled Type 2 diabetes mellitus have been found to have a more atherogenic lipid profile than Hispanic diabetic and non-diabetic men. How much of these abnormalities are reversible with control of diabetes is unknown. The benefits of strict glycemic control on the development of CVD in persons with Type 2 diabetes have not been established. Correction of lipid metabolic abnormalities has been seen when hyperglycemia is improved. However, the relationship between chronic hyperglycemia and other risk factors for CVD shown to be operative in diabetes mellitus (lipoprotein (a), plasma homocysteine and antioxidants) has not been described. This study will test the hypothesis that Hispanic women with poorly controlled Type 2 diabetes will result in a greater improvement in CVD risk factors than improved glycemic control in Hispanic men with poorly controlled diabetes. These risk factors and their improvement with diabetes control will be monitored over a 3-year period. If tight glycemic control restores gender differences in CVD risk factors, this study could have great implications regarding the treatment of diabetic women.