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CARDIOVASCULAR STATUS OF DIABETIC PATIENTS AFTER THE FOURTH DECADE OF LIFE

CARDIOVASCULAR STATUS OF DIABETIC PATIENTS AFTER THE FOURTH DECADE OF LIFE Abstract An analysis of the cardiovascular status of the diabetic patient involves chiefly a study of the interrelationship of arteriosclerosis and diabetes. One hundred and twenty cases in patients above the age of 39 have been observed with this in view. The data presented here deal with the incidence of the important cardiovascular variants, and with their relation to age and sex and to the severity and duration of diabetes. To these are added some observations on the clinical types of arteriosclerosis in diabetic patients and on the significance of retinitis and abnormalities of the electrocardiogram. The primary data are tabulated in table 1 and summarized in table 2. The relation to sex is shown in table 3 and to age in table 4. CARDIOVASCULAR VARIANTS Cardiac Enlargement. —The heart in nondiabetic arteriosclerotic patients is as often small as large. In the autopsy material analyzed by Cabot,1 64 per cent References 1. Cabot, Richard C.: Facts on the Heart , Philadelphia, W. B. Saunders Company, 1926, pp. 417 and 423. 2. These probably include some diabetic patients. 3. Nathanson, M. H.: Coronary Disease in One Hundred Autopsied Diabetics , Am. J. M. Sc. 183:495, 1932.Crossref 4. Warren, S.: The Pathology of Diabetes , Philadelphia, Lea & Febiger, 1930, p. 148. 5. Major, S. G.: Blood Pressure in Diabetes Mellitus . Arch. Int. Med. 44:797 ( (Dec.) ) 1929.Crossref 6. Kramer, D. W.: Hypertension and Diabetes , Am. J. M. Sc. 176:23, 1928.Crossref 7. Sherril, J. W.: Cardiovascular Disease in Diabetes Mellitus , California & West. Med. 38:73; 39:17, 1933. 8. Moore, R. F.: The Retinitis of Arteriosclerosis and Its Relation to Renal Retinitis and to Cerebral Vascular Disease , Quart. J. Med. 10:29, 1917. 9. Bessière, E.: Existe-t-il une rétinite diabétique en l'absence d'altérations rénales? Arch. d'ophth. 49:219, 1932. 10. White, Priscilla: Diabetes in Childhood and Adolescence , Philadelphia, Lea & Febiger, 1932, pp. 193 and 217. 11. Wagener, H. P., and Wilder, R. M.: The Retinitis of Diabetes Mellitus , J. A. M. A. 76:515 ( (Feb. 19) ) 1921. 12. Spalding, E. M., and Curtis, W. S.: Retinitis and Other Changes in the Eyes of Diabetics , Boston M. & S. J. 197:165, 1927. 13. Hepburn, J., and Graham, D.: An Electrocardiographic Study on One Hundred and Twenty-Three Cases of Diabetes Mellitus , Tr. A. Am. Physicians 43:86, 1928. 14. Joslin, E. P.; Dublin, L. I., and Marks, H. H.: Studies in Diabetes Mellitus: Its Incidence and the Factors Underlying Its Variations , Am. J. M. Sc. 187:433, 1934. 15. Emerson, H., and Larimore, L. D.: Diabetes Mellitus: A Contribution to Its Epidemiology Based Chiefly on Mortality Statistics , Arch. Int. Med. 34:585 ( (Nov.) ) 1924. 16. Joslin, E. P.: Diabetes: Its Control by the Individual and the State , Boston, Harvard University Press, 1931, p. 46 17. The Treatment of Diabetes Mellitus , ed. 4, Philadelphia, Lea & Febiger, 1928, p. 675 18. The Ten-Year Diabetic , Am. J. M. Sc. 175:472, 1928. 19. Joslin, E. P.; Dublin, L. I., and Marks, H. H.: Studies in Diabetes Mellitus: Characteristics and Trends of Diabetes Mortality Throughout the World , Am. J. M. Sc. 186:753, 1933. 20. John, H. J.: Diabetes: A Statistical Study of One Thousand Cases , Arch. Int. Med. 39:67 ( (Jan.) ) 1927. 21. Week. Bull., New York City Health Dept. 20:357, 1931. 22. Wendt, L. F. C., and Peck, F. B.: Diabetes Mellitus: A Review of 1,073 Cases, 1919-1929 , Am. J. M. Sc. 181:52, 1931. 23. Morrison, L. B., and Bogan, I. K.: Calcifications of the Vessels in Diabetes , J. A. M. A. 92:1424 ( (April 27) ) 1929. 24. Gray, P. A., and Sansum, W. D.: The Higher Carbohydrate Diet Method in Diabetes Mellitus , J. A. M. A. 100:1580 ( (May 20) ) 1933. 25. Leutenegger, F.: Diabetes Mellitus und Gefässystem , Ztschr. f. klin. Med. 119:164, 1931. 26. Bowen, B. D., and Koenig, E. C.: Arteriosclerosis and Diabetes Including a Roentgenological Study of the Lower Extremities , Bull. Buffalo Gen. Hosp. 5:31, 1927. 27. Rabinowitch, I. M.: The Cholesterol Content of Blood Plasma in Diabetes Mellitus , Arch. Int. Med. 43:363 ( (March) ) 1929.Crossref 28. Shepardson, H. C.: Arteriosclerosis in the Young Diabetic Patient , Arch. Int. Med. 45:674 ( (May) ) 1930.Crossref 29. Nathanson.3 Enklewitz, M.: Diabetes and Coronary Thrombosis , Am. Heart J. 9:386, 1934.Crossref 30. Joslin,15b pp. 375 and 678. 31. Barach, J. H.: The Incidence of Rheumatic Heart Disease Among Diabetic Patients , Am. Heart J. 2:196, 1926.Crossref 32. Penfield, W.: The Influence of the Diencephalon and Hypophysis upon General Autonomic Functions , Bull. New York Acad. Med. 9:613, 1933. 33. Joslin,15b p. 754. 34. John, H. J.: Diabetes: A Statistical Study of Two Thousand Cases , Arch. Int. Med. 42:217 ( (Aug.) ) 1928.Crossref 35. Warthin, A. S.: The Rôle of Syphilis in the Etiology of Angina Pectoris, Coronary Arteriosclerosis and Thrombosis and of Sudden Cardiac Death , Tr. A. Am. Physicians 45:123, 1930. 36. Joslin,15b p. 676. 37. Warren,4 pp. 124 and 148. 38. Wilder, R. M.: Necropsy Findings in Diabetics , South. M. J. 19:241, 1926.Crossref 39. Von Noorden, C.: Die Zuckerkrankheit und ihre Behandlung , ed. 5, Berlin, A. Hirschwald, 1910, P. 189. 40. Blotner, H.: Coronary Disease in Diabetes Mellitus , New England J. Med. 203:709, 1930.Crossref 41. Root, H. F., and Graybiel, A.: Angina Pectoris and Diabetes Mellitus , J. A. M. A. 96:925 ( (March 21) ) 1931.Crossref 42. Joslin, 15b. Levine, S. A.: Coronary Thrombosis: Its Various Clinical Features , Medicine 8:245, 1929. 43. Allbutt, T. C.: Arteriosclerosis: A Summary View , New York, The Macmillan Company, 1925 44. Diseases of Arteries Including Angina Pectoris , New York, The Macmillan Company, 1915. 45. Evans, G.: A Contribution to the Study of Arteriosclerosis , Quart. J. Med. 14:215, 1921.Crossref 46. Keith, N. M.; Wagener, H. P., and Kernohan, J. W.: The Syndrome of Malignant Hypertension , Arch. Int. Med. 41:141 ( (Feb.) ) 1928.Crossref 47. Fishberg, A. M.: Hypertension and Nephritis , Philadelphia, Lea & Febiger, 1930. 48. Klemperer, P., and Otani, S.: Malignant Nephrosclerosis (Fahr) , Arch. Path. 11:60 ( (Jan.) ) 1931. 49. Blitzsten, E. P. W., and Schram, D. L.: Diabetes: Electrocardiographic Studies , Arch. Int. Med. 36:770 ( (Dec.) ) 1925.Crossref 50. Lewis, T.: Mechanism and Graphic Registration of the Heart Beat , London, Shaw & Sons, 1925, p. 122. 51. Katz, L. N.: The Significance of the T Wave in the Electrogram and the Electrocardiogram , Physiol. Rev. 8:447, 1928. 52. Faulkner, S. M., and Hamilton, B. E.: The Electrocardiogram in Diabetic Coma , Am. Heart J. 8:691, 1933.Crossref 53. Middleton, W. S., and Oatway, W. H.: Insulin Shock and the Myocardium , Am. J. M. Sc. 181:39, 1931.Crossref 54. Soskin, S.; Katz, L. N.; Strouse, S., and Rubinfeld, S. H.: Treatment of Elderly Diabetics with Cardiovascular Disease , Arch. Int. Med. 51:122 ( (Jan.) ) 1933.Crossref 55. Smith, K. S., and Hickling, R. A.: Electrocardiographic Changes During Treatment of Severe Diabetes , Lancet 1:501, 1932.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

CARDIOVASCULAR STATUS OF DIABETIC PATIENTS AFTER THE FOURTH DECADE OF LIFE

Archives of Internal Medicine , Volume 55 (3) – Mar 1, 1935

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Publisher
American Medical Association
Copyright
Copyright © 1935 American Medical Association. All Rights Reserved.
ISSN
0730-188X
DOI
10.1001/archinte.1935.00160210024003
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Abstract

Abstract An analysis of the cardiovascular status of the diabetic patient involves chiefly a study of the interrelationship of arteriosclerosis and diabetes. One hundred and twenty cases in patients above the age of 39 have been observed with this in view. The data presented here deal with the incidence of the important cardiovascular variants, and with their relation to age and sex and to the severity and duration of diabetes. To these are added some observations on the clinical types of arteriosclerosis in diabetic patients and on the significance of retinitis and abnormalities of the electrocardiogram. The primary data are tabulated in table 1 and summarized in table 2. The relation to sex is shown in table 3 and to age in table 4. CARDIOVASCULAR VARIANTS Cardiac Enlargement. —The heart in nondiabetic arteriosclerotic patients is as often small as large. In the autopsy material analyzed by Cabot,1 64 per cent References 1. Cabot, Richard C.: Facts on the Heart , Philadelphia, W. B. Saunders Company, 1926, pp. 417 and 423. 2. These probably include some diabetic patients. 3. Nathanson, M. H.: Coronary Disease in One Hundred Autopsied Diabetics , Am. J. M. Sc. 183:495, 1932.Crossref 4. Warren, S.: The Pathology of Diabetes , Philadelphia, Lea & Febiger, 1930, p. 148. 5. Major, S. G.: Blood Pressure in Diabetes Mellitus . Arch. Int. Med. 44:797 ( (Dec.) ) 1929.Crossref 6. Kramer, D. W.: Hypertension and Diabetes , Am. J. M. Sc. 176:23, 1928.Crossref 7. Sherril, J. W.: Cardiovascular Disease in Diabetes Mellitus , California & West. Med. 38:73; 39:17, 1933. 8. Moore, R. F.: The Retinitis of Arteriosclerosis and Its Relation to Renal Retinitis and to Cerebral Vascular Disease , Quart. J. Med. 10:29, 1917. 9. Bessière, E.: Existe-t-il une rétinite diabétique en l'absence d'altérations rénales? Arch. d'ophth. 49:219, 1932. 10. White, Priscilla: Diabetes in Childhood and Adolescence , Philadelphia, Lea & Febiger, 1932, pp. 193 and 217. 11. Wagener, H. P., and Wilder, R. M.: The Retinitis of Diabetes Mellitus , J. A. M. A. 76:515 ( (Feb. 19) ) 1921. 12. Spalding, E. M., and Curtis, W. S.: Retinitis and Other Changes in the Eyes of Diabetics , Boston M. & S. J. 197:165, 1927. 13. Hepburn, J., and Graham, D.: An Electrocardiographic Study on One Hundred and Twenty-Three Cases of Diabetes Mellitus , Tr. A. Am. Physicians 43:86, 1928. 14. Joslin, E. P.; Dublin, L. I., and Marks, H. H.: Studies in Diabetes Mellitus: Its Incidence and the Factors Underlying Its Variations , Am. J. M. Sc. 187:433, 1934. 15. Emerson, H., and Larimore, L. D.: Diabetes Mellitus: A Contribution to Its Epidemiology Based Chiefly on Mortality Statistics , Arch. Int. Med. 34:585 ( (Nov.) ) 1924. 16. Joslin, E. P.: Diabetes: Its Control by the Individual and the State , Boston, Harvard University Press, 1931, p. 46 17. The Treatment of Diabetes Mellitus , ed. 4, Philadelphia, Lea & Febiger, 1928, p. 675 18. The Ten-Year Diabetic , Am. J. M. Sc. 175:472, 1928. 19. Joslin, E. P.; Dublin, L. I., and Marks, H. H.: Studies in Diabetes Mellitus: Characteristics and Trends of Diabetes Mortality Throughout the World , Am. J. M. Sc. 186:753, 1933. 20. John, H. J.: Diabetes: A Statistical Study of One Thousand Cases , Arch. Int. Med. 39:67 ( (Jan.) ) 1927. 21. Week. Bull., New York City Health Dept. 20:357, 1931. 22. Wendt, L. F. C., and Peck, F. B.: Diabetes Mellitus: A Review of 1,073 Cases, 1919-1929 , Am. J. M. Sc. 181:52, 1931. 23. Morrison, L. B., and Bogan, I. K.: Calcifications of the Vessels in Diabetes , J. A. M. A. 92:1424 ( (April 27) ) 1929. 24. Gray, P. A., and Sansum, W. D.: The Higher Carbohydrate Diet Method in Diabetes Mellitus , J. A. M. A. 100:1580 ( (May 20) ) 1933. 25. Leutenegger, F.: Diabetes Mellitus und Gefässystem , Ztschr. f. klin. Med. 119:164, 1931. 26. Bowen, B. D., and Koenig, E. C.: Arteriosclerosis and Diabetes Including a Roentgenological Study of the Lower Extremities , Bull. Buffalo Gen. Hosp. 5:31, 1927. 27. Rabinowitch, I. M.: The Cholesterol Content of Blood Plasma in Diabetes Mellitus , Arch. Int. Med. 43:363 ( (March) ) 1929.Crossref 28. Shepardson, H. C.: Arteriosclerosis in the Young Diabetic Patient , Arch. Int. Med. 45:674 ( (May) ) 1930.Crossref 29. Nathanson.3 Enklewitz, M.: Diabetes and Coronary Thrombosis , Am. Heart J. 9:386, 1934.Crossref 30. Joslin,15b pp. 375 and 678. 31. Barach, J. H.: The Incidence of Rheumatic Heart Disease Among Diabetic Patients , Am. Heart J. 2:196, 1926.Crossref 32. Penfield, W.: The Influence of the Diencephalon and Hypophysis upon General Autonomic Functions , Bull. New York Acad. Med. 9:613, 1933. 33. Joslin,15b p. 754. 34. John, H. J.: Diabetes: A Statistical Study of Two Thousand Cases , Arch. Int. Med. 42:217 ( (Aug.) ) 1928.Crossref 35. Warthin, A. S.: The Rôle of Syphilis in the Etiology of Angina Pectoris, Coronary Arteriosclerosis and Thrombosis and of Sudden Cardiac Death , Tr. A. Am. Physicians 45:123, 1930. 36. Joslin,15b p. 676. 37. Warren,4 pp. 124 and 148. 38. Wilder, R. M.: Necropsy Findings in Diabetics , South. M. J. 19:241, 1926.Crossref 39. Von Noorden, C.: Die Zuckerkrankheit und ihre Behandlung , ed. 5, Berlin, A. Hirschwald, 1910, P. 189. 40. Blotner, H.: Coronary Disease in Diabetes Mellitus , New England J. Med. 203:709, 1930.Crossref 41. Root, H. F., and Graybiel, A.: Angina Pectoris and Diabetes Mellitus , J. A. M. A. 96:925 ( (March 21) ) 1931.Crossref 42. Joslin, 15b. Levine, S. A.: Coronary Thrombosis: Its Various Clinical Features , Medicine 8:245, 1929. 43. Allbutt, T. C.: Arteriosclerosis: A Summary View , New York, The Macmillan Company, 1925 44. Diseases of Arteries Including Angina Pectoris , New York, The Macmillan Company, 1915. 45. Evans, G.: A Contribution to the Study of Arteriosclerosis , Quart. J. Med. 14:215, 1921.Crossref 46. Keith, N. M.; Wagener, H. P., and Kernohan, J. W.: The Syndrome of Malignant Hypertension , Arch. Int. Med. 41:141 ( (Feb.) ) 1928.Crossref 47. Fishberg, A. M.: Hypertension and Nephritis , Philadelphia, Lea & Febiger, 1930. 48. Klemperer, P., and Otani, S.: Malignant Nephrosclerosis (Fahr) , Arch. Path. 11:60 ( (Jan.) ) 1931. 49. Blitzsten, E. P. W., and Schram, D. L.: Diabetes: Electrocardiographic Studies , Arch. Int. Med. 36:770 ( (Dec.) ) 1925.Crossref 50. Lewis, T.: Mechanism and Graphic Registration of the Heart Beat , London, Shaw & Sons, 1925, p. 122. 51. Katz, L. N.: The Significance of the T Wave in the Electrogram and the Electrocardiogram , Physiol. Rev. 8:447, 1928. 52. Faulkner, S. M., and Hamilton, B. E.: The Electrocardiogram in Diabetic Coma , Am. Heart J. 8:691, 1933.Crossref 53. Middleton, W. S., and Oatway, W. H.: Insulin Shock and the Myocardium , Am. J. M. Sc. 181:39, 1931.Crossref 54. Soskin, S.; Katz, L. N.; Strouse, S., and Rubinfeld, S. H.: Treatment of Elderly Diabetics with Cardiovascular Disease , Arch. Int. Med. 51:122 ( (Jan.) ) 1933.Crossref 55. Smith, K. S., and Hickling, R. A.: Electrocardiographic Changes During Treatment of Severe Diabetes , Lancet 1:501, 1932.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Mar 1, 1935

References

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