DIABETES MELLITUS, CARDIOVASCULAR DISEASE AND HORMONE REPLACEMENT THERAPY M PERERA AND MA LUMSDEN Department of Obstetrics and Gynaecology, University of Glasgow, UK INTRODUCTION Diabetes mellitus is the most common chronic disease in the industrialized world. In North America and Europe the prevalence in adults is 7–8% and it is estimated that there are more than 100 million cases worldwide. 1 With the increasing prevalence of non-insulin-dependent diabetes mellitus (NIDDM) this figure con- tinues to rise. 2,3 The World Health Organization predicts that the number of patients with diabetes will rise from 130 million to over 300 million over the next 25 years. 4 Diabetes affects 1 in 30 people living in England and Wales and accounts for more than £2 billion of hospital costs annually. The number of diabetic patients in the UK is predicted to double to 3 million by the year 2010. 5 The predominant clinical form of diabetes mellitus is type 2 or NIDDM, which accounts for 90% of all cases. Type 2 diabetes occurs with an equal frequency in both sexes and is most common in obese individuals over 40 years of age. Certain racial groups have a higher incidence: for example, Asians, native Americans, Africans and Islanders in Nauru and Mauritius. DIABETES AND CARDIOVASCULAR DISEASE Cardiovascular disease (CVD) occurs with a higher than normal frequency in association with diabetes and is a major cause of morbidity and death in diabetic patients. 6 In the USA, coronary heart disease (CHD) accounts for 75% of all deaths in type 2 diabetes. 7 In the UK, fatal cardiovascular disease is 70 times more frequent than fatal microvascular complications in diabetics. 8 Furthermore, studies have shown consistently that women with diabetes have a greater risk of CHD than male diabetics (Figure 1). 9–13 Address for correspondence: MA Lumsden, Department of Obstetrics and Gynaecology, The Queen Mother’s Hospital, Yorkhill, Glasgow G3 8SJ, UK. 153 Reproductive Medicine Review 2000; 8:2 153–72 # 2000 Cambridge University Press Printed in the United Kingdom