The macrovascular complications of diabetes include coronary artery disease (CAD), stroke and peripheral vascular disease. About 65% of deaths in diabetic patients are attributable to heart disease and stroke. Mortality from cardiac disease in diabetic patients is two to fourfold higher than that in non-diabetic individuals (1). Furthermore, diabetic patients have a two to four times higher risk for developing a stroke compared with their non-diabetic counterparts. The risk of macrovascular complications has not been shown to be higher in ethnic minority populations (16,17); despite a higher prevalence of diabetes and hypertension, especially in African Americans. A similar observation has been made in Africans in developing countries (18) and the UK (3), where the incidence of CAD is low in diabetic patients. Although cerebrovascular disease is a common cause of death in African diabetic patients, especially those with concomitant hypertension, CAD is uncommon (18). For instance, in Nigeria where the prevalence of diabetes may be more than 7% in some urban centers (19), the prevalence of CAD (by autopsy) in patients who died suddenly from cardiac causes is only 4% (20). There may be a mitigating factor protecting the minority patient from excess CAD burden as may be predicted from the disparate prevalence of diabetes and hypertension. The etiology of this discordance is not known with certainty, although it is thought to be due to less atherogenic lipid profile in African Americans. Understanding the nature of this factor may hold a promise for reducing the incidence of CAD. Even though the prevalence rates of macrovascular complications are similar among the ethnic groups, mortality from CAD is higher in the high-risk ethnic populations, particularly African-American women (21). The reason for this disparity, which merits further study, remains unclear.
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