Diabetes and Cardiovascular Disease: The “Common Soil” Hypothesis
Abstract
Unlike classical microvascular complications, large-vessel atherosclerosis can precede the development of diabetes, suggesting that rather than atherosclerosis being a complication of diabetes, both conditions have common genetic and environmental antecedents, i.e., they spring from a "common soil." It is now known that adverse environmental conditions, perhaps related to less-than-optimal nutrition, in fetal and early life are associated with an enhanced risk of both diabetes and cardiovascular disease many decades later. These same adverse environmental conditions are also associated with the development in adult life of abdominal obesity and the insulin-resistance syndrome (IRS). The IRS consists of glucose intolerance, hyperinsulinemia, dyslipidemia (high triglyceride and low high-density lipoprotein [HDL] cholesterol levels), and hypertension. Although the mechanism underlying this cluster is controversial, the statistical association is well established. All of the elements of the IRS have been documented as risk factors for type II diabetes. Some, but not all, of these elements are also cardiovascular disease risk factors, in particular, hypertension and low HDL cholesterol. Other factors associated with the IRS that may enhance cardiovascular disease risk are plasminogen activator inhibitor 1 and small, dense low-density lipoprotein particles. Whether insulin itself is a risk factor remains controversial, but recent epidemiological evidence has been mostly negative. T…
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Statin prescriptions also appeared among important predictors, consistent with their indication for patients with diabetes and cardiovascular risk factors whose greater clinical complexity increases the likelihood of experiencing acute events requiring emergency care.
“Statin prescriptions also appeared among important predictors, consistent with their indication for patients with diabetes and cardiovascular risk factors whose greater clinical complexity [86,87] increases the likelihood of experiencing acute events requiring emergency care [88–90].”
From Machine learning-driven risk prediction for post-hospitalization diabetes case management: Integrating clinical and social determinants of health (2026) · cites this paper as [86]
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- Authors
- Stern, M. P.
- Affiliations
- Division of Clinical Epidemiology, Department of Medicine, The University of Texas Health Science Center San Antonio, Texas
- Venue
- Diabetes
- Publisher
- American Diabetes Association
- Published
- 1995-04-01
- Volume
- 44
- Issue
- 4
- Pages
- 369-374
- ISSN
- 0012-1797 (ISSN-L)
- 1939-327X
- OpenAlex
- W2140429097
- Cited by
- 739
- References
- 1
- Citations by year
- 2026: 9 · 2025: 7 · 2024: 12 · 2023: 27 · 2022: 20 · 2021: 17 · 2020: 33 · 2019: 28 · 2018: 31 · 2017: 18 · 2016: 12 · 2015: 18 · 2014: 19 · 2013: 22 · 2012: 28
- FWCI
- 10.27
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- type 2 diabetes, cardiovascular disease, large artery atherosclerosis, metabolic syndrome, fetal programming, early life exposure, abdominal obesity, dyslipidemia, hypertension, HDL cholesterol, plasminogen activator inhibitor-1, small dense LDL, hyperinsulinemia, intensive insulin therapy, cardiovascular risk factors
- MeSH terms
- Cardiovascular Diseases, Diabetes Mellitus, Diabetes Mellitus, Type 2, Humans, Insulin Resistance, Cholesterol, HDL, Nutritional Physiological Phenomena, Obesity, Risk Factors, Syndrome
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