Diabetes, Fish Oil, and Vascular Disease

The major cause of death in patients with diabetes mellitus is macrovascular disease, particularly coronary heart disease, stroke, and atherosclerosis of the lower extremities. Indeed, the incidence of these ischemic complications is 1.7 to 4 times greater in men with diabetes than in men without diabetes and is 2.7 to 6.4 times greater in women with diabetes than in women without diabetes [1]. The presence of diabetes even eliminates the usual protection from coronary disease that premenopausal women have compared with men of similar age. Diabetic persons of either sex have had a two- to four-fold increase in mortality in population studies done throughout the world [2]. The development of atherosclerosis is greatly accelerated in persons with diabetes [3].

The reasons for increased vascular disease in diabetic persons are not completely known, but certain risk factors are much more common in patients with diabetes, especially adult-onset diabetes (non–insulin-dependent diabetes mellitus). These risk factors include hypertension, hyperlipidemia, visceral obesity, and hyperinsulinemia and have been called the “deadly quartet” or “syndrome x” [4, 5]. Several approaches may be taken to the prevention of coronary disease and peripheral atherosclerosis in persons with diabetes. Better glucose control is certainly one answer, but it is sometimes difficult to achieve in the free-living, affluent, and sedentary U.S. population. Diet and drugs can be used to …