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The risk for all the manifestations of atherosclerotic disease is increased in patients affected by type 2 diabetes mellitus. The aim of the present work was to evaluate the prevalence of coronary heart disease (CHD) in a well-characterized middle-aged and elderly Italian diabetic population. The population studied included 3862 subjects, i.e. all the patients affected by type 2 diabetes of age >or=50 years attending the outpatient diabetes care unit of INRCA in Ancona (Italy) from 1 August 1997 to 31 July 1998. We collected and analysed both clinical and laboratory data by means of a computerized data base for the outpatient clinic management. The prevalence rate of CHD was 20.25% in this population. The groups with CHD and without CHD did not differ significantly with respect to age at onset of diabetes, body mass index and HbA1c levels, while patients with CHD were significantly older than patients without CHD and had a longer duration of diabetes. The prevalence of patients with hypertension (52.9 vs 63.0%, P<0.001), hypercholesterolemia (11.6 vs 14.1%, P<0.05) and hyperlipidemia (17.8 vs 23.3%, P<0.001) was significantly higher in the group of diabetic subjects affected by CHD than in patients not affected by heart ischemic disease. It might be hypothesized that the improvement of metabolic profile and the currently feasible control of non-diabetic risk factors could reduce cardiovascular disease rates in type 2 diabetic patients.

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Age-related macular degeneration (ARMD) is one of the leading causes of vision impairment in the elderly and its frequency in general population increases with aging. The etiology of this disease has remained so far unknown. The relationship between ARMD and diabetes mellitus was studied in the present work. Fundus oculi was investigated in 292 diabetic patients older than 50 years and with more than 14 years of duration of diabetes (time since diagnosis). A group of 375 non diabetic, non hypertensive subjects matched for age was studied as control. ARMD frequency was significantly higher in diabetics compared to controls (p < 0.005); and also in type II diabetics (non-insulin dependent diabetes mellitus = NIDDM) compared to type I (insulin dependent diabetes mellitus = IDDM) (p < 0.001). Older diabetic patients showed an increased frequency of ARMD while no correlation with the duration of the disease emerged. Macular damage was not linked to microangiopathy (retinopathy), hypertension or gender; on the contrary, it appeared to be associated with dyslipidemia. On the basis of these data one can conclude that diabetes mellitus can exert an unfavorable effect on macular age-related phenomena even if the pathogenetic mechanism is at present obscure.

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The causative relationship between metabolic control and long-term complications of diabetes is still under debate. Recent studies suggest that a strict glycemic control can often prevent the development of microcirculatory impairment but the role played by chronic hyperglycemia in the pathogenesis of retinopathy remains controversial. We report the results of a retrospective study of data collected on a ten-year period and concerning the relationship between glycemic control and retinopathy. A group of 46 Type I diabetic people was studied. Results indicate that the probability of developing retinopathy or of worsening the degree of a pre-existing retinopathy is higher in patients with poor metabolic control. Deterioration of metabolic control (increase of HbAlc% levels) appears to be related to a progression of retinal lesions. On the contrary, retinopathy is not influenced by aging and duration of diabetes mellitus.

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Apolipoprotein (apo) E polymorphism was examined in a population of Italian blood donors. A significantly reduced frequency of the epsilon 4 allele was observed in comparison to a combined Caucasian population. Apo E polymorphism was also associated with significant differences in plasma lipid and lipoprotein levels. Notably, total and low-density lipoprotein cholesterol as well as triglycerides were increased, whereas high-density lipoprotein cholesterol was decreased in carriers of the E4 isoform. This is the first report of a significantly lower frequency of the apo E4 isoform in a European population. The reduced occurrence of an apo E isoform, which is associated with a more atherogenic lipid/lipoprotein profile, may be a contributory factor to the relatively lower incidence of cardiovascular disease in the Italian population.

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Human recombinant erythropoietin constitutes a remarkable improvement in the treatment of uraemic anemia. Nevertheless, it causes haemorheological changes, which in turn may affect smaller blood vessel circulation. Our study was conducted on a pool of chronic uraemic patients under hemodialytic treatment who were given erythropoietin therapy. Substantial increases in overall blood viscosity and red cell aggregation were recorded, with no change in erythrocyte deformation. An increase in cardiovascular morbidity might occur in these patients who are already liable to this condition. Several years will have to elapse and thorough studies will have to be conducted on a large number of patients, to have conclusive evidence on this point.

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In a study on the prevalence of cardiovascular autonomic neuropathy and retinopathy in a group of 57 diabetic subjects, an increased prevalence of these complications related to the duration of diabetes has been found.

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