Book Review

Diabetes and Cardiovascular Disease

N Engl J Med 2006; 354:1099March 9, 2006

Article

Diabetes and Cardiovascular Disease
(Contemporary Cardiology.) Second edition. Edited by Michael T. Johnstone and Aristidis Veves. 641 pp., illustrated. Totowa, N.J., Humana Press, 2005. $145. ISBN: 1-58829-413-7

Timing is often everything. Certainly, the second edition of Diabetes and Cardiovascular Disease could not have been published in a more timely fashion, given that the worldwide incidence and prevalence of diabetes are increasing at an alarming pace. And as noted by the editors, diabetes truly is a cardiovascular disease.

The concept that diabetes is a cardiovascular disease is gradually being accepted; diabetes is often referred to as a coronary-disease equivalent. It is not possible for cardiologists and cardiovascular surgeons to avoid treating patients with diabetes. However, the fragmentation of patient care has reached such proportions that cardiologists and cardiovascular surgeons often do not manage the diabetic component of a patient's illness nearly to the extent that would be of greatest benefit to the patient. Books such as Diabetes and Cardiovascular Disease provide a great resource for readers needing to learn more about the relationship between these disease entities.

This book is a serious attempt to provide a comprehensive review of the basic and clinical aspects of diabetes and the cardiovascular system. Conveniently, the chapters are separated into two parts — one part on the pathophysiology of diabetic cardiovascular disease and the other on clinical aspects. Each chapter is written by highly regarded experts in their respective areas of focus, and thus, the material is presented with clarity and in detail. Both experimental and clinical data are provided to characterize the role of diabetes in producing vascular disease, including atherosclerosis and hypertension, heart disease (cardiomyopathy, heart failure, and coronary syndromes), and peripheral vascular disease. It is refreshing that much attention is focused on the peripheral vascular complications of diabetes, since they result in substantial morbidity and mortality.

Although “the metabolic syndrome” is discussed at length in the book, little space is devoted to the controversy surrounding this term. In fact, the American Diabetes Association discourages its use. I myself believe that the use of the term has assisted the practicing primary care physician in treating global risk in patients with this phenotype, but its use does not add anything to the assessment of global risk beyond what the individual components of the syndrome delineate.

The book does not address the management of diabetes in detail. In future editions, the editors might consider expanding the comprehensive management of diabetes to include care by generalists and those in cardiovascular specialties, since there will clearly not be enough “diabetologists” to care for the millions of patients with this disorder. And greater participation in the care of such patients by cardiologists and cardiovascular surgeons is needed.

This book is recommended for any serious student of diabetes. In particular, cardiologists and cardiology fellows, as well as cardiovascular surgeons and cardiovascular surgical fellows, should be familiar with the material in it. It is also a valuable resource for those with more advanced knowledge of diabetes, such as endocrinologists and researchers active in the field of diabetes and cardiovascular diseases. The reader must bring more than a passing knowledge of diabetes to reading this book in order to obtain the full benefit of having such expert information compiled in one source. This is not a book for the casual reader or for someone wanting a quick, easy guide to managing diabetes in practice.

Thomas D. Giles, M.D.
Louisiana State University School of Medicine, New Orleans, LA 70112
tgiles4@cox.net