Diabetes mellitus for 25 years or more. Analysis of cardiovascular findings in seven patients studied at necropsy.
Observations are described in seven patients (four women and three men) aged 38 to 76 years who had had diabetes mellitus for 25 years or more. Five had been treated with insulin, and two had been treated with diet and oral hypoglycemic agents only. Four patients had had bilateral leg amputations, one angina pectoris, and two left-sided congestive heart failure. Two died suddenly, two died of acute myocardial infarction, two died of infection, and one died from trauma. Transmural left ventricular scars were present in five patients and transmural necrosis in three patients. All seven patients had two or more major epicardial coronary arteries narrowed more than 75 percent in cross-sectional area by atherosclerotic plaque. Of 353 segments, each 5 mm, from the four major epicardial coronary arteries from the seven patients (mean 50 per patient), 53 (15 percent) were narrowed up to 25 percent in cross-sectional area, 116 (33 percent) were narrowed 26 to 50 percent, 110 (31 percent) were narrowed 51 to 75 percent, 66 (19 percent) were narrowed 76 to 95 percent, and eight (2 percent) were narrowed 96 to 100 percent. What allowed such long survival in these seven patients is unclear. It is clear that all had severe coronary arterial narrowing by atherosclerosis.
D000328:Adult; D000368:Aged; D003331:Coronary Vessels / Q000473:pathology*; D048909:Diabetes Complications; D005260:Female; D006331:Heart Diseases / Q000150:complications*; D006352:Heart Ventricles / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors